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ECTRICAL PERMIT AFLICATION <br /> CITY OF EVERETT PERMIT SECES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: J � �' ,sciA <br /> e._ <br /> BUILDING AREA(if residential, new construction, remodel, or addition) \' V SF <br /> BUILDING TYPE: ❑ SFR-DETACHED R-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: �c �r�� \� vy� \/\...(;) <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ gj 0 ry 0 <br /> NUMBER OF DEVICES (if low voltage): I <br /> FIRE ALARM? 0 YES X1/0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 5(Z'S3`c CC_)\\LCA G 1 4\Cc) <br /> RSC C <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NA E(If Commercial): <br /> *� �y . <br /> OWNER MAILING ADDRESS: sTF2EET�3� I '\CX....)e)'.<1/4).�pL kt ''''''���pppfff���i <br /> CITY�\f�� , STATE ZIP C(Cgr7, J <br /> OWNER PHONE: OWNER EMAIL: v` <br /> CONTRACTOR NAME: 'e V\G›`� E\ a- -C G" <br /> CONTRACTOR ADDRESS: STREET dC..�( L -H <br /> cry <br /> �/ r( \ I�q J�/J \ STATE \j'0 ZIP< c <br /> CONTRACTOR PHONE:1-/ )210 / O CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):�t t��rl� ? r-� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): D5 /L <br /> PRIMARY CONTACT: 0 OWNERNTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM;, CONTACT PHONE: Li--7„,SC <br /> CONTACT EMAIL: � .\ ktC,; <br /> AGREEMENT:T hereby certify tba1 I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE (� <br /> �ov � <br /> / - <br /> /- PERMIT# <br /> E VY0 <br /> Owner/A ;.011111.e.5-Agent Sig Pe Date (Revised 10/12/2015) <br />