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�CTRICAL PERMIT A�ICATION <br /> CITY OF [VERETi PFRUII S[RVICES j —�3 —�� <br /> 3200 CEDAR S1R[[T. EVERETT, WA 98201 �'/6p/ —O'�3 <br /> (f') 4'15-?57-fl810 � �AX 425-257 8857 � (E) evere;teps@everethva.gov � �•n�,n•�everettwa gov/permits <br /> PRQJECT SITE INFORMATION <br /> PROJECTADURE55: o� <br /> BUILDING AREA;J�esiaerLai, rew conslrucUon remode� or ar,C��Don) _f �__ SF <br /> BUILDING TYPE: ❑ SFR-DETACHEO ❑ SI=R-ATTACHED ❑ UUPLEX ❑ IdUI TI-FAI�91lY - #OP UNIT�S__._. _ ,�CO'AWi[RCIAI- <br /> USE OF �U�LDING: G-Q S Y��� � � C� V�'F�J <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: S � 9 7..� <br /> NUMBER OF DEVICES (`�cw vo,taae): � _ <br /> FIRE ALARM? ❑ YES �NO <br /> ASSOCIATED BUILDING PERMIT# pf appiicable): <br /> DESCR�PTION OF WORK: �H Y � T r -t / t �� f/2S� � <br /> I S � n /le " - VC.' ' � fl.f Y' � �Cp PC"f // W 5 �. <br /> .� ' ' �� <br /> CONTACT INFORMATION <br /> OWNER NAME� TENANT NAME pf Commcrcial�: C1� e(//'Ar� <br /> OWNER MAILING ADDRESS: siFeer <br /> Orv SinL :iv <br /> OWNER PHONE: OWNER EMAII: <br /> CONTRACTOR NAME: �liQPt (�i� ,���7�� /f� l�C S <br /> CONTRACTOR ADDR[55: v•.i.��, � G(/ G{/, _ (�"5��7 S"� S� � ' /� <br /> qtv ✓ C_C� S1AiE i�P/ �/ <br /> CONTRACTOR PHONE: � � S 3 � �/ CONTRACTOR EMAIL: �Se.� eLSS� r� • C-�71'� <br /> CONTRACTOR L�C. #pa_Ouua�u): V GS /�/ �� � CITV OF EVERETT�USINE55 LIC.p(RI?OWnED): <br /> PRIRIARY CON7ACT: ❑ OWNFR CONIRAC70R U OTHFR �P�easr, Specdy) _ _ <br /> CONTACT NAME: CONTACT PHONE: y� — �J� D��J <br /> � G �. p--f- CONTAC7 EMAII: �� C�eSS� �7` . C ��7 <br /> �1Gl;L[ilCNT. Them6ycertr/y1ba11havereadande+aminedlfus.�pn4whona�AMmelhes,imeobetroeandcmred Allp•omsomo/lans�ndo�d�nancesgoreminglh.s <br /> ype ol ccik r.��l be rompleletl x�hClher spenhedhemm ornol 7hr qrammg ol n psrtn;does nnI gres,unc lo c'�'e ao:hor,ly lu:o�olo a cancellhe provisons o�any o;hersfa:c o� <br /> iocall.v�vicye'al,ng<c�vlmcGonoNlrePedamanceolcons.'mcf�on llraflamau,'home�7:ylliear:nero/I1nsGre4,�,}y,loPerlumlheu�orklonvh,chaPPbcalmnamadeantll <br /> com/:!y�'.,.'h thc Sla'o Co�,h:?cicr La�v iD 27 FCLl'a��A 23�iG0l7S1C <br /> Qty 0/Evereff C/hoa!USC Oaly <br /> FEE <br /> � IJI,�% <br /> PERMIT Y. <br /> .� - � 3- /,� � � � r� � - 0�3 <br /> OwnedAut riz � AgenlSignaWrc D:i7c (Revised 10.I71'07S) <br />