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ELECTRICAL PERMIT APPLICATION <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: �C/ ;�Tff (, � <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: L rC�-/j �,c�,���J �rZ��� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): ,(� <br /> FIRE ALARM? ❑YES f�NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: f'�,v�,Si� �LCCT �z �.%�L ia�� 2 �+C wl�t-/l�= o�� c�,�>>-z����. <br /> L c' i �i f, Z,v s l t c �Ni C Z G--:�c f�A�/) ��.�� L.���i r,�.vc— <br /> CONTACT INFORMATION <br /> OWNER NAME: /(%��Z/y h',�ovi� TENANT NAME(If Commercial):�G�L�Ni��s'� 2ctLo F���,,a� S<, �i�c y <br /> OWNER MAILING ADDRESS: sTREET /�, t� , J3 v 3 � <br /> C/�/�"/J �� S CITY ��/' STATE ZIP ���' �d <br /> OWNER PHONE: L�ZJ � 7�_� L� ,�Z�/ OWNER EMAIL: LL� � ,t�Gr/ ���e'. C��h <br /> CONTRACTOR NAME: /U ,�� � N� <br /> CONTRACTOR ADDRESS: srReeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L`�j, 3 y Y _ �� �� <br /> /��.ZGi�/�9E� �L� icr��.z CONTACT EMAIL• �.j��y�Ec C=C��c6���� 7,�- �i Gh�1C •G y^ <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correcf. All provisions of laws and ordinances governing this type <br /> 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 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 /> PERMIT# <br /> ��.; � � �b -s-is E <br /> Own�rized Agent Signature Date (Revised 9/23/2016) <br />