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�LECTRICAL PERMIT AI�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@everett�va.gov � vnnv.everetiv+a.gov/permits <br /> /2- -�5~ <br /> PROJECT SITE INFORMATIUN <br /> PROJECTADDRESS: Z Q ; Wq <br /> BUILDING AREA(d residen6al, nev+construction, remodel, oraddition) . � T'�\et 1 SF <br /> BUILDING TYPE: C SFR-OETACHED ❑ SFR�ATTACHED ❑ DUPLER ❑ MULTI-FA�SILY-:OF UNITS ❑ CON1�dERCIAL <br /> USE OF BUILGING: f l�j�g �t-l�a� i�1/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: S (�Q <br /> NUMBER OF DEVICES (if loa�voltage): <br /> FIRE A�,SRM? ❑ YES O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> i I <br /> DESCRIPTION OF WORK: /� ;n � �' a U -{�If�S �Y <br /> M <br /> CONTACT INFORMATION <br /> OWNER NAME: 5 TENANT NAME(If Commcrcial): <br /> OWNER MAILING ADDRESS: sraeer ; �,,L; <br /> C�Tv ��/Pj(CJ�� Sint[ W /'r z;r � � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAM[: ^ QI.� IL' -f t�I S���Gl°S <br /> CONTRACTOR AD�RESS: ssvee� �O•T� �'�1� (j S� <br /> �,,, �.4 _� Sd-e�r`,� �.,,,,� �,,,'I� .,�,°(82,S <br /> CONTRACTOR PHONE: � - � – Ob L3 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC. Np2[(]UiRFD)� � I�p $ . C� CITY OF EVERETT BUSINESS LIC.#�REOUIR[U).C�d�1�iV <br /> PRIMARY CONTACT: ❑ OWN[R �.CONTRACTOR ❑OTHER(Plea,c Specify) <br /> CONTACI NAME� ��� S CONTACT PHONE: l�-Z – Z ,. U� I <br /> A�ON� p CONTACT EMAIL: <br /> AGREEM1"FNT T hereby cert�ly thaf I have mad and ex;miined(his oppbcafion and Fnm.the s;�mv l0 60(rue and cor�ecl All provisrons ol lau5 and orAmances 9ovCmnrq Ilus <br /> type ef�:oM wtll6e comp/eletl��,tieMer specd�etl�emm or not. The r,ranfmg ol a perm f Coes r,ot p;rsume W 91ve aulhony 7o vrolafe or cancellhe pmv�svns ol ony oHu�r sla!e c. <br /> loc,�llow rtgulaGng eonsfiucfron orthe peAormance o/conslmc!ion ihal l am aulhunrud by Ne o.�ner ollhr,pmperiy(a pCAoml fhe�voM lor wh�ch u(pbcaho.o is mdtle and I <br /> cnrnp�y rv,N Ihn Sfalc Conln.clors Larv 7B.27 FGW an�29G200{:�AC <br /> C.fy ol Eve/eff OMcial Use Only <br /> FEE <br /> � �o oa <br /> . <br /> PBRMIT# <br /> , � � II <br /> !,��; i� /�9�1s E i � ia— <br /> Owncr/A— ut�AgentSignalure ate �— (Rc�isetl70/iZ2015! <br />