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�CTRICAL PERMIT A� .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: ,5/l� L� ,� � � <br />BUIIDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: COMMERCIAL <br />USE OF BUILDING: e c� /� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $/ Gb <br />NUMBER OF DEVICES if low volta e): <br />FIRE ALARM? ❑ YES �NO <br />ASSOCIATED BUILDING PERMIT #(if a plicable): <br />DESCRIPTION OF WORK: ��� �j �� �' v,� �� J� <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): ��, rvc�c>c. �1�u' e <br />OWNER MAILING ADDRESS: srReET ��U (�' C�'1 %-2d <br />c/��� �/ ��' <br />CITY � ��� { � STATE �'� ZIP l � " � <br />OWNER PHONE: �� �'� � 3 Z� / 5S / OWNER EMAIL: <br />CONTRACTOR NAME: �Uv�'L� S t'Gl � lt Z�� ��v�/i [� � � L <br />CONTRACTOR ADDRESS: sTREET �'�� /��/ G J Lcc lc-e' /�v� v� <br />CITY /.- (�� ✓�� N STATE v" '/ ZIP �r7 � G� <br />CONTRACTOR PHONE: ZaG �/✓Z7 3yS s CONTRACTOR EMAIL: ��ut �'-�! ���ry��`"` �S S/'�c r c".�� <br />CONTRACTOR LIC. #(REQUIRED): S�U ,OS �% CITY OF EVERETT BUSINESS LIC. #(REQUIRED): S`�3 �// <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: /�� fJ •— � �J„� �� �� <br />/� v' �D� CONTACTEMAIL: <br />AGREEMENT: T hereby certify that I have read and examined this application and know the same to be trve and correct. All provisions of laws and ordinances goveming this <br />type 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 fhe performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Agent Signature <br />�/2��//� <br />Date <br />City of Everett Official Use Only <br />FEE <br />�� <br />`�ip-'�� <br />PERMIT # <br />E � ��� - ��� <br />(Revised 10/12/2015) <br />