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C�� <br /> _ � � <br /> "ECTRICAL PERMIT AFr` �ICATION l ��. �� <br /> CITY OF EVERETT PERMIT SERVICES � ' /Z°� <br /> 3 2 0 0 C E D A R S T R E E T, E V E R E T T, W A 9 8 2 0 1 � <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �'� � � j �Q v � � �� '� �O�j <br /> BUILDING AREA(if residential, new construction, remodel,or addition)��1�"lG��-� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: � ��a�� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $` � � " �j <br /> NUMBER OF DEVICES (if low voltage): I�U <br /> FIRE ALARM? YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: �<,.\ \��r1C �C��� � C�1'�� CO�-�e Y� <br /> ��- � � c.GE Ss -�rto <br /> CONTACT INFORMATION <br /> OWNER NAME: � U 1Q�S L(,� � " �J�'O��YI TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREET � � �}�, \ �� `VC� c <br /> ciTv '�'1/�� � sTnrE �. ziP (_���� <br /> OWNER PHONE: ; � �� ' I OWNER EMAIL: <br /> CONTRACTOR NAME: �J� ��L�f f� GtV .� ��'��,t�C� <br /> CONTRACTOR ADDRESS: sTReeT � • �1 � ��7���� <br /> cirv. If � (j� sTnTE �j�J '� ziP C� `�l <br /> CONTRACTOR PHONE:� l�C� � -`Y�C�-/ CONTRACTOR EMAIL: �j`C, C4- ��'(,LIC�� 0.��(X.x;���1(:� :b� � <br /> CONTRACTOR LIC.#(REQUIRED): �� . ^CSS�� �C� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5��,75 <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR �OTHER(Please Specify)�V� -S� �-E'_ (,�"Y� �C'�� � <br /> CONTACT NAME: CONTACT PHONE: J --,��' � -� � <br /> �,' �� � �, h� V� CONTACT EMAIL: <br /> AGREEMENT:T hereby certi(y 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 <br /> type o/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 ol construction. That I am authonzed by the owner o/this property to perform the work(or which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City o(Everett Official Use Only <br /> FEE <br /> � � 0� <br /> �) IIPERMIT# <br /> ' E � I �o��- �a.5 <br /> � �,� � � �-y- - ► <br /> � w er/Authorize Ag nt Signature Date (Revised 10/12/2015) <br />