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t�ECTRICAL PERMIT AP�I A <br /> C TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �(/1 (� <br /> BUILDING AREA(if residential, new constructio , 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: $ b�O <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if a licable): <br /> DESCRIPTION OF WORK: �b �� C l ✓LvL,�'� V I�G�% li0(�}'l/) <br /> ✓1 D�'^ �_,i�f����1 ��. t� � � <br /> I✓� ��—G�� �ri�:-h, ��/\ <br /> CONTACT INFORMATION <br /> OWNER NAME: ��1�1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer �� I G`-C/� � <br /> CITY � STATE nI ZIP � v �"' <br /> OWNER PHONE:�2�� I ' ��J u OWNER EMAIL: � � "1 <br /> CONTRACTOR NAME: �_ G`-V�� � (n.V�.� '� <br /> CONTRACTOR ADDRESS: sTaeer� I�l,� � S� � <br /> CITV���1,�' �� �"�� Y v` `�- STATE " `� ZIP ✓�. <br /> CONTRACTOR PHONE:��� ��( `�I� CONTRACTOR EMAIL: (V�J lil-� (�'- �'��-'� <br /> CONTRACTOR LIC.#(REQUIRED): w�� �/� � u 'T�Q � CITY OF EVERETT BUSINESS LIC.#(REQUIRED)aS��GI � <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> ONTACT NAME: CONTACT PHONE: ���� l� � <br /> � J�� v CONTACT EMAIL: I ���- V`� • <br /> AGREEMENT.�T hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this <br /> type of work will be completed whether specified herein or not. The granting of a permd does not presume to give authority to violate or cancel the piovisions of any other state or <br /> local law regulating construction or the pertormance 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 /> Ciry of Everett Official Use Only <br /> FEE <br /> � �� o�� <br /> � PERMIT# <br /> c�� ( �� , �- E �'l b �--�(�� <br /> Owner/Aut orized Agent Signat Date (Revised f0/12/20i5) <br />