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ECTRICAL PERMIT AF _ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�P1 �.7�_7�7_3iR1(J ..� r,�1: Q?�r2r.]_Rf�:?7" I`G1.osit,�rc�}pn�%n,la�iacaH.�i� �rnG I Nn'V::'.:y.�orolfi�i� .^.f)��i�;?fr?"��}c <br />� PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � 4 Z� , ��' G �c(c-� �-v` �'=: f�; �=[r <br />BUILDING AREA (if residential, new construction, remodel, or addition) i'�%� SF <br />BUILDING TYPE: SFR-DETACHED ❑ SFR-Al-fACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: �j�t � � L � <br />CONTACT INFORMATION <br />OWNER NAME: ,^p �p ry�9 �� il ��1 �� �C �� k► � TENANT NAME (If Commercial): --' <br />OWNER MAILING ADDRESS: s�eeT �� 7�}- � -:�Lr�-� a,�' <br />CfTY � �'� _ t STATE v'�7,/-� ZIP ��� �. Z -C �% �' <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: �'� Y� � � 1 f�C`-�- �C <br />CONTRACTOR ADDRESS: s�eeT I�j ( L - e%�.��,�� yry '-c= `� <br />CfTY .�.�V1Cir 1 ti;��� L_ �.. STA'TE V�l' .'l�� ZIP C�L�f� <br />CONTRACTOR PHONE: �j (c�C: —l�� �' `�Gc�� CONTRACTOR EMAIL: , � �. u"`"�Y � Yl � �= ��L �7 �C.) �C . jl�` <br />CONTRACTOR LIC. #(REQUIRED): T^t�- � �.` i�.= L ej �„ �'k? ..Y' CITY OF EVERETT BUSINESS LIC. #(REQUIRED): C�� L`i`S <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONT CT NAME: CONTACT PHONE: � <br />� (�.-�C �' �- �' - S� o c; <br />�� � � �ti� � �7 � � CONTACT EMAIL: 1' C'. � � 'T1�1 1� � C•I �t�. ��"1 �- � �C , tl.Q. � <br />A�rtttnatN �: � nereoy cert�ry rnar i nave reaa ano examineo rn�s appucanon ano Know rne same ro �e rrue ano correcr. Au provis�ons or �aws ano orainances govemmg rrris <br />type of work will be completed whether specified herein or nof. The granting of a permif does not presume to give authority to violate or cancel the provisions of any other stafe or <br />local /aw regulating construc:�or, or the performance of construction. That I am authorized by the owner of this pr�perty to perform fhe work for which application is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />:�_�.._: L <br />Agent SPgy tu <br />�I:����. <br />Date <br />City of Everett O�cial Use Only <br />FEE <br />I �1�� oa <br />PERMIT # <br />E ?��,�-����. <br />(Revised 10/1212015) <br />