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�CTRICAL PERMIT AF _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: q I `Q �,�j V � . � � t� ►Q,�f � �„Q rvltw-� <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: � �LQ, Ct�S r QO y►�S <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ � ��Q <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: � 1��Q '�i Y��QVJ Of�UGS �lY <br />-e,r �d Cw1" 3 I�1 vt, �v,�ea/ o vti � e �+.r ` Le <br />i I <br />CONTACT INFORMATION <br />OWNER NAME: �/,Q,Y.Q,'� ,�/�,0� �'� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREET �' � � <br />CITY v��f STATE � ZIP 2 O� <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: (� Y� \ Cy�'�') �/l S <br />CONTRACTOR ADDRESS: srReeT � � V,C � � <br />CITY ��� �/t/L 1 S", STATE �� ZIP I <br />CONTRACTOR PHONE: �L "'rj '' � J �y CONTRACTOR EMAIL: �S �✓1 . ol-��-i D�f/LL�t�'�-Q. ,� df�1� <br />CONTRACTOR LIC. #(REQUIRED): S 2lAC(,� � 2 Q(� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): S S <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � G� .� <br />�� � CONTACT EMAIL: � � . ��[,� �� ��-f�/.�, �� <br />AGREEMENT: T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />type of work will be completed whether specified herein or not. The granfing of a permit does not presume to give authorify to violate or cancel the provisions of any other state or <br />local law regulating construction or the 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 />City of Everett Official Use Only <br />FEE <br />���� � C� <br />PERMIT # <br />E I (�� �,`�-- ���Z <br />(Revised 10/l2/2015) <br />