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�LECTFtICAL PERMIT A�LICATION <br />CITY OF EVERETT PERtUi(T S�RVICES <br />3200 CEC3AR STREET, EVERETT, WA 982C11 <br />(P} 425-�57-881Q � FAX 425-257-8857 �{E) everetfeps c'�'s)evereit�nr�.gc�v � www.everet€wa.gc�vt�ermits <br />PRt?.IECT St'i"E IN�4RMA7'�t�N ` <br />PRQJECT ADDRESS: i � ,.�.`�, -; ;j i <� --�. a- --.jr�" /F� "~ ' <br />BUILDING AREA (if residential, new construction; remodel, w addition) j;� �,;��° SF <br />BUILD{NG TYPE: ❑ SFR-DETACHED SFR-ATiACNED ❑ �UP�EX 0 MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />U3E OF BUI�DING: ��-> �- 1:-=., <br />ELEGTRIGAL ARPLICATIaN INFC1EtMAT10N <br />CCINTRACT PRICE OF WORK: $ <br />NUMBER OF DEVIGES (if low volta e): <br />FtRE A�ARM? 0 YES 1�N0 <br />ASSOCIATED BUILDING PEftMIT # (if applicabie}: <br />DESCRIPTION t?F WORK: ;�°; . ,- _ � �, -� , � <br />G�NTACT INFORMATI4N <br />OWNER NAME: TENANT NAME {If Cammercial): <br />OWNER MAILING ADDRE55: srrEET <br />CITY STA7E ZiP <br />UWNER PH4NE: dWNER EMAIL: <br />GONTitACTQR NAME_ �- �- V y,�'<, <br />CONTRAC70R ADDRESS: sTReer �"�; t'�j "�` � t% � �k' i� ��` �`"� ��.- <br />CIlV � (,? y^ �aP � � STATE �r�, j't �j ZiP � � ;� 3 1,,,� <br />CONTRACTOR PHONE: �,� �o �> � `��-I,3� CONTRACTOR EMAIL: �.�.�'r�ce-r��€�i. �'_%�����'�� �-�����`� �.%%#"�'�`� <br />CONTRACTOR UC, #{REQUtRED): � f� �:. t/1 r� `� �y �, `t CITY OF EVERETT BUSINESS LIC. #(REQuiRED}: �;} -'tj 1�;;y �_. <br />PRIMRRY CONTACT: � OWNER �CONTRACT()R C7 OTHER (Please Specify) <br />CONTACT NAME; Ct]NTACT PMONE: ��g� �c� � ��.� �� <br />�� <br />�"�V'l�c'�.Y'i��t�.. ��t��t,�d"�":� �s'�``s CONTACT EMi41L= �',,,�rcc:;:r����a„ �� �b�ru= r��c�,r>'�' -C.,� rt�-s <br />AGK��MENT: 7 hereby cerfliy ttraf ! have read and examined fhrs application and know ttts same to be true and correcf. A(! provrsions nf laws ant! ordinances �oveming fhis <br />iy,oe of �vork wilf be complefed whether spec�ed herein or not. 7"he granting of a permit does not presume to yive authonty to violate or cancel fhe provisians of any other siate or <br />loca! law regutating construction orthe performance ot canstructron. That i am aufhanzed by the owner of this praperty to perionn the work for which appfication is made and ! <br />cnmpty with the Sfate Contracfors Law 1827 RCW and 236_200 WAC. <br />OwnerfAuthorized Agent Signature C <br />Ciry of Everefi Official Use Only <br />FEE <br />� ���/i ��� <br />V' ► <br />PERMIT # <br />� � 'V� � ��� <br />(Revised 10/12/2D15) <br />