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� <br />ELECTRICAL PERMIT APP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � � �� � �;, ��C ��V� L ���i-%� � �'��`' ��� � <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: OMMERCIAL <br />USE OF BUILDING: ,�� \ l� l�� p" ��U 4--t���% _ � � <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ %'C�(;% ` ` <br />NUMBER OF DEVICES (if low volta e): <br />FIRE ALARM? ❑ YES NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: ,� c.� C_ c,� r �— �; o�.— <br />�i� � � �� . <br />CONTACT INFORMATiON <br />OWNER NAME: �( � c��-1� L L� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: s-rReeT � �/2�/„ s '� ��'1n-(� (� <br />CITY Z'�,����� STATE l./�� ZIP ���� <br />OWNER PHONE: �LL7�-- 3`�jrj ^" �Yc �3 OWNER EMAIL: <br />CONTRACTOR NAME: I /��iC�71- � c- (��� <br />CONTRACTOR ADDRESS: srReeT �C? /'� �� <br />CITY - ����� G STATE �" � ZIP QLU � <br />CONTRACTOR PHONE: �S - �� r �� ___ �Q�TRACTOR EMAIL: t �e r � � �� Q'vL-1-� C -�/' � � �- __._ <br />.._-- _ � - < <br />CONTRACTOR LIC. #(REQUIR D): C� �j��E� ��'f Z�'tit� CITY OF EVERETT BUSINESS LIC. #(REG2uIRED): � �,�' <br />�- �_�-�__: _ _,-_. _- <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) -- <br />CONTACT NAME• p CONTACT PHONE: ��}--� �(� ��- �-( �1' � � <br />���'i��� � i r"`D(..t-�/ CONTACT EMAIL: J,'�( ��G( � ( ��-- � - `�`..� � l G _ ('-er 1.�, <br />AGREEMENT: T hereby certify that i have read and examined fhis application and know the same to be t�ue and correct. All provisions of laws and ordinances governing this <br />type of work will be complefed whether specified herein or not. The grenting of a permit does nof presume to give authority to violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />City of Everett Official Use Only <br />FEE <br />S�� .c�� <br />PERMIT # <br />E �C.��� --� ��--� � <br />(Revised 10/12/2015) <br />