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�ECTRICAL PERMIT AI�LICATION <br /> CITY OF EVERETT P[RMIT SL=RVICES C �S/Z f(Oy <br /> 3200 CEDAR STR[ET, EVERETT, WA 98201 J Z�,a"3..15 <br /> (P) 47.5-257-8810 � FAX 425-257-8857 � (E) everetteps@everettv✓a.gov � w�w�.everettwa.govlpermiis <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: D 1 � <br /> BUILOING AREA(d resideM�al, new construct�on, remodel, or atldilion) SF <br /> BUILDING TYPE: ❑ SFR-0GTAGHED ❑ SFR-ATTACHED ❑ DUPIEY ❑ tv1ULT1-FAMIIY -#OF UNIT3 ❑ COMA4ERCIAL <br /> USEOFBUILDING: ��-pC�,v 4 �h�S\c�`Fr.+`c,� O <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTf.ACT PRICE OF WORK: 5 O�— <br /> NUMBER OF DEVICES (d lov+voltage): <br /> FIRE ALARM? ❑ YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# Qf applicable): p <br /> DESCRIPTION OF WORK: �p�,,,9 �(7 ��� b pcY ��<�` � <br /> r <br /> CONTACT INFORMATION <br /> OWNER NAME: �, 5 TENANT NAME Qf Commcrcial): <br /> OWNER MAILING ADDRE55: srve=_r r� C' I <br /> cirv sTRre O <br /> OWNER PHONE: -i� ^�—I "'3 S OWNER EMAIL: <br /> CONTRACTOR NAME: ' . o f t <br /> CONTRACTORADDRESS: srRcrr � � <br /> cnv oG)O si,ve zm <br /> CONTRACTOR PHONE: a.y ' CONTRAC70R EMAIL: S �J _ n <br /> CONTRACTOR LIC. #(HeOWRED�: S , o CITY OF EVERETT BUSINESS UC. M(R[OWRBD): �j <br /> PRIMARY CONTACT: ❑ OWNFR ,� CONTRACTOR ❑OTH6R(Pleasc Speufy)___ _ _. — <br /> CONTAC"f NAME: CONTACT PHONE: aS_ —a f <br /> � � CONTACT EMAIL: <br /> AGREEF.;EM T hea��y cert�ty Ihaf I have mad antl er;mnned Ih�s apP�,caM1un ond 6now Ihe:'+me ro Ge f�i�e and correcf A��pmvaions of laws and orOrn:rnces gov�mm9 fl%�� <br /> type o!woik�v�'10e rompleted wheMer speuGed herern or rml The g�anDnq cl a F"rtrnl Aoes no!pmsu.^e lo rroe aulhonfy In v�olate or cancel fhe pmv�swn:ol any e!hrr sfafe oi <br /> Incall.nvreyu'ahngco��sln24onorfhe0edormanceofconslmcnon 7ndtlama�Al'onzedbylAeo�vnerellh4��operfyloperlorrnthewmklorwh:chappLcafion�s��a0eantll <br /> mmpy�vAn!Fa Slafe Confn,clo�s Law 1H?7I7CV✓and 236.^.CO IYaC <br /> City of E�erelf Oil�aal Use Oniy <br /> rer_ � <br /> �� vi <br /> P�RIdIT� <br /> � �-- �a -�.�- � � E I � 1Z - I �� <br /> Owncr/Authorized Agent Si�naWrc Date (Rcv�sM 70/12/2075J <br />