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� <br />�� <br />ELECTRICAL PERMIT APPLICATION <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 />PROJECTADDRESS: Z� 1` C�py� CV�rG.�}' A �Q I <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: L7 COMMERCIAL <br />USE OF BUILDING ���grGLu.\ Ot't'�� � c�.C., <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ Z, I UU <br />NUMBER OF DEVICES (if low volta e): � <br />FIRE ALARM? L�'YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />DESCRIPTION OF WORK: � v� �4 \��ov� � *'�'o � k2 ir ss�i�' 'o <br />c�J � c,� : ���r� S �C M <br />CONTACT INFORMATION <br />OWNER NAME: 4,r� �j�'. �ro ��t ��, TENANT NAME (If Commercial): c� �,�x..> ,c� <br />OWNER MAILING ADDRESS: sTReer Z�l� pv�a. �r V�,}� UO <br />CITY �}t.J`t�T STATE W'A ZIP � (�ZU <br />OWNER PHONE: _1L5� Z5Z — G�{ U-` OWNER EMAIL: <br />CONTRACTOR NAME: W ��v� v� W�.t'M <br />CONTRACTOR ADDRESS: sTReeT "j U (� {�ir gv�t wca � <br />CITY �u�"�'�`Q� STATE V�/ I"� ZIP V� 7 <br />CONTRACTOR PHONE: ZUE7' Z — 1$ DU CONTRACTOR EMAIL: �v\S�c�ll ��,,n t-� rrn. L r�n <br />CONTRACTOR LIC. #(REQUIRED): ASL-�T ALZ.�'j L'3 CITY OF EVERETT BUSINESS LIC. #{REQUIRED): UZ, 3�j�( <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR E�OTHER (Please Specify) Grrh �-� r�i v�c. r <br />CONTACT NAME: CONTACT PHONE: D(� �'i� (� —�3 (� I <br />�uvlv� �fnC�c�..S CONTACTEMAIL: Q�r„ti��S '� �Qr 1����r„� <br />ACiKttMtN l: I nereby certity that I nave �ead and examined th�s appl�cat�on and know fhe same to be t�ue and co�7'ecL All provis�ons o� laws ana ordlnances govern�ng th�s <br />type of wo�k will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br />local law regulafing construction or the performance of construction. That / am authorized by the owner of this property to perform the work for which application is made and I <br />compty with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />�o� <br />OwnerlAuthorized Agent Signature Date <br />City of Everett Official Use Only <br />FEE <br />( C�"� �� C � <br />PERMIT # <br />E �;C 7� � �-�� <br />(Revised 10/12/2015) <br />