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ECTRICAL 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: �� '� S���.� � ����Z� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) ��v SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � :U�O <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: �-� ��_�� �,X1S�"�,.� ;���2���,; h.; I1 ���''�-r '� (_ <br /> � � . ,1�. "2�� e�2�S �-c; \�, ���J �onn �1� 0 �� c,-���ti ;- <br /> c� � Z���' C.R--�L � � •� c-'� ��'�S � ' �C.:�`�f �cK� <br /> ... <br /> CONTACT INFORMATION <br /> OWNER NAME: a Y��.�J'Z5�' . ,� G� \CG� � ' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET j iv I VO S �`A-��-� O���� <br /> ~�J'Q tj't CITY STATE ZIP <br /> OWNER PHONE: �Z� �3`� `f •- C�Z7 l� OWNER EMAIL: <br /> CONTRACTOR NAME: `• l�� ���c��( � <br /> CO TRACTOR AD RESS: sTReeT ,j�' <br /> � �' � CITY // � STATE ��/ ZIP <br /> CONTRACTOR PHONE: �S 21�� �yj� I CONTRACTOR EMAIL: � ' �'�►+�� ,��1�'�l� G , /� /• C C�/7�� <br /> CONTRACTOR LIC.#(REQUIRED): �U�� �'' ���J� Ll CITY OF EVERETT BUSINESS LIC.#(REQUIRED):G, � �J <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR �,OTHER(Please Specify) G� , •�,r Cm� <br /> CONTACT NAME: ��,�L��.(L� ��Zk�,.�J'(� CONTACT PHONE: j—�jG�}-�11,�— �vj%%•�j� L,� 2��'S�j "�S ,/� <br /> �2� 3.� " a�� � CONTACT EMAIL: j,ta�-�r�c <br /> AGREEMENT. T hereby certify that 1 have read and examined this application and know the same to be true and correct. AII provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume fo give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 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 /> ��� ''� �" �' ` <br /> � � � �'���=- <br /> PERMIT# <br /> E ���� -� ���'n <br /> � , <br /> Own IAuthorized Age Signature Date (Revised 10/12/2015) <br />