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�ECTRICAL PERMIT A�LICATION <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: � � n --�.�"� <br />�� G�'j- � i' "= �, �t_� �- � � c5- �t G �`� / <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETiaCHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: �,�3 COMMERCIAL <br />USE OF BUILDING: ��i_. -`� L� � I-� �'L CT' U���' ��� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WOFtK: $ „� <br />NUMBER OF DEVICES (if lovv voltage): <br />FIRE ALARM? ❑ YE:i ❑ NO <br />ASSOCIATED BUILDING PE:RMIT # if applicable : <br />DESCRIPTION OF WORK: J ��L� � U� T�i7— I/,J i'7 �f ����� r <br />j�G' ����.5/ c`�,'`� <br />CONTACT INFORMATION <br />OWNER NAME: r��,�'7�� �� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srrteET � �� G'�j��� �7 j <br />CfTY Qf- � V'L� ��_. ��T�- STATE C41,� ZIP `[�� �� I <br />OWNER PHONE: ��-�� ��,�;�,� • J j� �(�� OWNER EMAIL: <br />CONTRACTOR NAME: / /" �� , — l�- ��/ �� � � �%�` ��i %��� <br />CONTRACTOR ADDRESS: s�eeT I (� r" ��� I�� (/(/ u� 7�� %� <br />��, � � ,%��( t. � �3 � <br />� " "' ") �j STATE ZIP <br />CONTRACTOR PHONE: `7��� -� � v���� CONTRACTOR EMAIL: %�%�� L�C� I�(�C `%J(�-, '1-� <br />CONTRACTOR LIC. #(REQUIRED): � L��--� ` `� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): JIS� <br />PRIMARY CONTACT: ❑ OWNER �"'CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �,S— ��j ._ �j� Q <br />�I � � �' S S CONTACT EMAIL: ��(�,'!� /1.�,�SS C:✓ ���/YV�}'%�, G�SY�''L <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 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 the perfoimance of construction. That l am authorized by the owner of this property to perform the work for which application is made and I <br />comply with fhe State Contractors Law 18.27 RCW and 296.200 WAC. <br />0 <br />,; <br />�. . <br />OwnerlAuthorized Agent g� <br />� <br />Date <br />City of Everett Official Use Only <br />FEE <br />�� � � � <br />PERMIT # <br />E �C��� �- 1�i <br />(Revised 10/12/2015J <br />