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� <br />�- <br />ELECTRICAL PERMIT APN�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 />1C�(�� PROJECT SITE INFORMATION <br />PROJECT ADDRESS: . �''�i -���. � �G.. � � � <br />BUILDING AREA (if residential, new construction, remodel, or addition) ��', O 1� � SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATT"ACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: 2 � ,� COMMERCIAL <br />USE OF BUILDING: v� ` ��_� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ )�v <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? � YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: � ;,�, �,� 5�ti� ,c � <br />CONTACT INFORMATION <br />OWNER NAME: � � � ��� ` ,a , �..�w�-� TENANT NAME (If Commercial): CC L_ �,�f �n�s <br />OWNER MAILING ADDRESS: srREEr ��(� � � i� �� .� �( z�-� ,J �� Z �� <br />CITY S�u �-l�, y"�� � C� STATE �-✓ �.� ZIP C, �'J � I� <br />OWNER PHONE: '2,-� � S� - Gj0 OWNER EMAIL: <br />CONTRACTOR NAME: �� �_ �L � <br />CONTRACTORADDRESS: srREer (D � � '��` l/�. "�I 2 `( <br />CITY � �� K j Ci� � STATE ZIP `/L��� <br />CONTRACTOR PHONE: �,� S 7 � � — C� L. CONTRACTOR EMAIL: �`� �� �� �' t'v. ( �_`� •, , , C - C-O (i� <br />CONTRACTOR LIC. #(REQUIRED): � �T�v �}_L ��GIMCp CITY OF EVERETT BUSWESS LIC. #(REQUIRED): �C� ! � <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: l�� S� 7��,- � 7 C�Z--- <br />� �� �� L � ` CONTACT EMAIL: dµ� � - � i � �;,� <br />i'j t: v� _ e�. � C-� <br />AGREEMENT. T hereby certi(y that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />fype of work 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 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 Confractors Law 18.27 RCW and 296.200 WAC. <br />Owner/AuthqfizedAgent Signature <br />/z _/�_ z �---- <br />Date <br />City of Everett Official Use Only <br />FEE <br />��>�( �° <br />PERMIT # <br />E i��� I��� <br />(Revised 10/12/2015) <br />