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� <br />� <br />�ECTRICAL PERMIT AP�CATION <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: / 30 Mt�i// w 4� <br />BUILDING AREA (if residential, new construction, mode , or addition) 30CY) SF <br />BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: C`�COMMER.CIAL <br />USE OF BUILDING: � � ' � �� ��yL �(s <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ 3`�� <br />NUMBER OF DEVICES (if low voltage): 7 <br />FIRE ALARM? ❑ YES C�NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: Ol�lOi•�c �xiSfi�G �-Ar✓� l�-tse�frs�s �Sl-�u-c-�f7 � Aivd Ao/d �/7aid� <br />f{o k� it <br />CONTACT INFORMATION <br />OWNER NAME: � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srrzEET '/( /�,�� <br />CITY �(J..p.�� STATE ZIP �8 �� � <br />OWNER PHONE: -�07- yp�.�' OWNER EMAIL: � ,r; ,� Sa,p oG <br />CONTRACTORNAME: AI��G� U. t� n <br />CONTRACTOR ADDRESS: srReer (�t� . ,N <br />CITY � D R%Q• STATE (/J ZIP jf <br />CONTRACTOR PHONE: - � - (� CONTRACTOR EMAIL: ✓�D � �( „ <br />CONTRACTOR LIC. #(RE(1UIRED): �.L.r SV CITY OF EVERETT BUSINESS LIC. #(REQUIRED): d23/�$ <br />PRIMARY CONTACT: ❑ OWNER CL?�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT: T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances gove�rning this <br />rype of work will be comp/eted whether specified herein or not. The grenting of a permit does not presume to give authority to vio/ate or cancel the provisrons of any other state or <br />local /aw regulating construction or the pertormance of construction. That I am authorized by the owner of this property to perform the work for which application is rr�ade and 1 <br />comply with the Sfate Contractors Law 18.27 RCW and 296.200 WAC. <br />Ownerj'Authorized P�g�nt Signature <br />2-8 -1� <br />Date <br />City of Everett Officia/ Use On/y <br />FEE <br />� �� , �C� <br />PERMIT # <br />E I � �Z - �� �� <br />(Revised 10/12/2015) <br />�� <br />