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�LECTRICAL PERMIT APP•LICATION <br /> CITY OF EVERETT PERMIT SERVICES � ..JC/.��� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425•257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa gov J w�we everettwa gov/permits <br /> � PROJECT SITE INFORMATION <br /> PROJECTADDRESS: � U�- ��1��1� <br /> BUILDING AREA(d residenual,new construclwn, remodel,or admt�on� ���9�e1 1�✓ SF <br /> BUILDING TYPE: ❑ SFR-DETACNED ❑SFR-ATTACHED �DUPLEX ❑MUITI-FAMILY-#OF UNITS ❑COMMERCIAL <br /> USE OF BUILDING: T�4�%�C�� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: 5 'L.�7p� <br /> NUMBER OF DEVICES h cow vo�la e : <br /> FIRE ALARM7 0 YES 49.N0 <br /> ASSOCIATED BUILDING PERM1iIT N if a licable : <br /> DESCRIPTION OF WORK: C � � � yl C� � <br /> CONTACT INFORMATION <br /> OWNER NAME: 'T�E 1�E S 1 � MD{•� TENANi NAME(II Commercial : <br /> OWNER MAILING ADDRESS: srncer IQ 2Z U�13 �I� <br /> cm � ��� s TE � C�' j <br /> u n� — <br /> OWNER PHONE: l3FA) ' 1 — "O OWNER EMAII: <br /> CONTRACTOR NAME: � F 1� ' � ♦ LCG l. �+L � <br /> CONTRACTORADDRESS: srneer S �fl�� �Lt-'Y�..� I � <br /> cm X�l7 V�I�� Q- no 2 �¢' <br /> \ iiATf <br /> CONTRACTOR PHONE: � G[. �� ZU • GE4 7� CONTRACTOR EMAIL: f C�.R-R1 � rGM7 Sf f�.T <br /> CONTRACTOR LIC.NIREOUIR[D�: j�VF=IJSE��=A K CITY OF EVERETT BUSINESS LIC.q�RFOuiR601: 1 <br /> PRIMARY CONTACT: ❑OWNER '�CONTRACTOR ❑OTHER�Please Speay) <br /> CONTACT NAME: , CONTACT PHONE: �zU (� y� <br /> S 7E✓E '��:fL/S CONTACT EMAIL: � <br /> AGREEIdENT T6erebycerlrytAallDavema0andexemm�y(h�sap0lKabonanClnowl�BsamelobelrueanEcorrpcl Ailprons�onso��awsando�tlmancesAovemmg�Ns <br /> rype ol wod wii!Do oomO�teU wnefAer spccA�ed Aemm or nof T�e g�nfmp al a permR aoes nnf Amsumc(o gne aul�ortry fo violale or w�[M f�eO�vrSiont ol any o1Der sfefe o! <br /> /aca/law rtgulahnq constructron or f�e pedortnante ol tonshuction T�al l am euNo�zed Dy fAv ar�ner ol fAis property to peAorm Me w0ik lo/�vhrc�appl,:ahOn t5 matlo enE I <br /> Compy wR�MC SYaN ContreClors Law 79 27 RCINand 196 100 WAC <br /> C�ty o!Evemtt Olfiaal Use Onry <br /> fEE <br /> I d 0 °� <br /> PERMIT# <br /> � 3 r5 E f�nOl --d�� <br /> Owne AuthorizeUAgentSignaturo Date (Rev�sMfo�t24oLy <br />