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LLE-CTRICAL PERMIT AP _ICATION <br /> CITY OF EVERETT PERMIT SERVICES <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: Z� G(a2oca 1 L- � &\IC-o(/ 1 J <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -#OF UNITS:_ ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: S <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: �; •Z�7 �� (� <br /> CONTACT INFORMATION <br /> OWNER NAME: �� �/� S ( A C`) �)n(�1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sT-R=Etr-"� 2 C <br /> C17YIAI- <br /> OWNER PHONE: 1 J' OWNER EMAIL: •L <br /> CONTRACTOR NAME: 1' 1 �✓ <br /> CONTRACTOR ADDRESS: <br /> iy <br /> CITY S1AlE <br /> CONTRACTOR PHONE: IV75"531- 0 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC. #(REQUIRED): vi IC- CITY OF EVERETT BUSINESS LIC.#(REQUIREDI <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �21 <br /> CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT; <br /> E j (,�O, - N <br />