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���iRICAL PERII�IT LICATIOIV <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 IPIFORMAT10�1 <br />PROJECT ADDRESS; �t t I�-p 'f� /�J� <br />BUILDING 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: �5 � ��,/� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ �i �;�� � <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES O <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: �T� J��. <br />CONTACT INFORMATION <br />OWNER NAME: � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT I(� C� �� V� <br />CITY STATE � � ZIP � `bp�{j ` <br />OWNER PHONE: ��-S �t2-�— � I�) OWNER EMAIL: <br />_ __ .._.. _. . _ _ __ . _.. . _._ _ _ _ . _. .. __ _ _ _ ._ _ . _ <br />_ . __. . ._ _..._ _ . .... ._.. <br />_ . . __. __ . <br />CONTRACTOR NAME: �L^ (1� �� ' S -4—'�Z-- <br />CONTRACTOR ADDRESS: sTReer �p � I`� �� v`� � L �� <br />CITY �" �""` STATE �'� ZIP l��� � <br />CONTRACTOR PHONE: ��� 4 U�� CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): -� h Z� `� 11�-� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): C� S���� <br />PRIMARY CONTACT: �—OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: l.� ?j � 4 �5�(� <br />�� CONTACT EMAIL: <br />AGREEMENT: T hereby cerfify that I have �ead and examined this application and know the same to be frue 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 permif does not presume to give authority to violate or cancel the provisions of any other state or <br />local law regulating consfrucfion or the performance of construction. That ( am authorized by the owner of fhis property to perform fhe work for which application is made and 1 <br />comply wiih the State Contracfors Law 18.27 RCW and 296.200 WAC. <br />Signature Date <br />City of Everetf O�cial Use Only <br />FEE <br />�no�� <br />PERMIT # <br />� I(OCi-1 �� <br />(Revised 90/12/2095) <br />