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�CTRICAL PERMIT AP�ICATION <br /> CITY OF EVERETT PERMIT SERVIC[S G � S / / �-7 S� <br /> 3200 C[DAR Sl'REET, EVERETT, WA 98201 ��_a L� �/ 5 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@evereltwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Z Q <br /> BUILDING AREA(d res�dential, new conslruclion remodel, or adddion) SF <br /> BUILDING TYPE: O SFR-0ETACH[D ❑ SFR-ATTACHED ❑ DUPLEX Q IdULT6FA�dILV-t!OF UNITS ❑ COA7MERCIAL <br /> USE OF BUILDING: ��' � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: 5 � <br /> NUMBER OF DEVICES (d low volta e): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable) _ _ <br /> DESCRIPTION OF WORK: 7'NC+- II � �\ n'rlo� 1:��`C�1\t�o� �1<<L G�`Qr�� �'L.�1,f� <br /> CONTACT INFORMATION <br /> OWNER NAME: j ' TENANT NAME�1f Commcrcial�: <br /> OWNER MAILING ADDRESS: sme=_r � 'JJ <br /> un .D srnrE :iN <br /> OWNER PHONE: OWNER EMAIL: <br /> � CONTRACTOR NAME: � � ' <br /> CONTRACTOR ADDHESS: srweer 7. L� <br /> arv .9 W� sinic_ A. <br /> CONTRACTOR PHONE: c�6— —�,3 CONTRACTOR EMAIL:c,s n n SS�' � ' <br /> CONTRACTOR IIC.NIR�Ou�REDC �1�1 (r' CI7Y OF EVERETT BUSINE55 LIC, pp2E0WR[o�: <br /> PRIMARV CONTACT: ❑OWNEfi �CONTRACTOit ❑ OTH[R (Please Specily)__. <br /> CONTACT NAME: CONTACT PHONE: C�a,S 4 5 — <br /> � � CONTACT EMAIL <br /> �7GREEh!ENT T heieby cemy Ihaf I have mad and e.am�netl this a/'P��caOon and Fno���t�e same ro Ce Ime and co�recf All pronsrons o�lawt antl orOm,nces govemmg rhrs <br /> A'ne o����orh�rJl be corn0lefetl a�helhrr specJ�ed hemin o�nof The g�an6n9 0�a pe�A does nol presume to q���e uulhonry to vrolafe or cancel Ihe pmms�ons o/any ofne-sfate oi <br /> locai iaw mQulafmq consWUion er'he pedovnanre ol conslrucfion TOaI I am aufhonzed Oy the o�vner ol nu;p�operty lo perlonn Me wo�k lor w,hicli aopi�cahon rs matle ana I <br /> comAN���th Ihe Sfate Confracfors La��� iB)7 HCW and 296 2001vAC <br /> Gty ol Everetf OH�aa�Use Onlv <br /> FEE J <br /> � y� I <br /> � l ' � O <br /> PERId1T# <br /> � Q -�- ���.�y _ t � E I� l I - I �� <br /> OwnerlAuthoriecA Agent Signature Date (Revisetl70i12/20t5/ <br />