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�,����i��� ����a�- �������io� <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 />EL.ECTRICAL. APPLICATIOPI INFORMATION <br />CONTRACT PRICE OF WORK: $ lD g(JU <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES [kl..NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): � <br />DESCRIPTION OF WORK: .r'w ' L� l C,' <br />r- �—.0 `3 <br />' CONTACT INFORMATION <br />OWNER NAME: c�0 441.-� `�j tn� �5��(� �lJ TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReeT �"i � Z3 ��s�{�f �(�W 1.--�'' <br />CITY -� �i �� STATE � <br />OWNER PHONE: L'L� Z32— �1 '�jg OWNER EMAIL• <br />CONTRACTOR NAME: ,/�� ,�� L� �� ''����--T �D� �'" L �-L�'� Y�-lG l.. <br />CONTRACTOR ADDRESS: sTREET _/ gO �I l�9G� S( S(j <br />ZIP �ZJ �� <br />CIN ��C'> �/ti(,) � STATE LV ZIP ( UZ�%� <br />CONTRACTOR PHONE: �"�2� 3 �jLZ � CONTRACTOR EMAIL: ;�,,t'�I,[..BI�C.-1�.JS��Wy t1� LZL?L-� k.�C- w<- Cv <br />CONTRACTOR LIC. #(REQUIRED): /1%D1Z�I�LI � S° Ll '7 _�_ A CITY OF EVERETT BUSINESS LIC. #{REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />GONTACT NAME: CONTACT PHONE: L.e Z� "� Z 9 G� Z� ( <br />`,'E"�.1. �!1'� l� CONTACT EMAfL: /�jl�(s�GU'�jQ1/1-i/�4-!Tl()A� l.''L�IiC•�-1�-- ��-L � <br />AGREEMENT: T hereby certify that I have read and examined fhis application and know the same to be true and correct. All provisions of la�vs and ordinances goveming this <br />type of work will be completed whefher specified he�ein or not. The granting of a permit does noi presume to give auihonty to violate or cance/ the provisions of any other state or <br />local law regulating construction or the performance of construcfion. That 1 am aufhorized by the owner of this property to perform the work for which applicafion is made and 1 <br />comply with fhe Sfate Contracto�s Law 18.27 RCW and 296.200 WAC. <br />Owner%Authorized Agent Signature <br />//�/z� /Zr��� <br />Date <br />City of Everett Official Use Only <br />FEE <br />��/ <br />PERMIT # <br />� l l!G l � � I � <br />(Revised 90/12/2015) <br />� <br />. <br />� <br />� <br />