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I: �CTRICAL PERMIT AF : _ICATION <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: J� I f ���� �\ - �� �i'_ <br /> BUILDING AREA(if residential, new construction, remodel,or addition) ,\C W�,v��_ SF ����U <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: $ ��;v ;�C} <br /> NUMBER OF DEVICES (if low voltage): '�� <br /> FIRE ALARM? ❑YES J[�NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: � -i„���� ' � ����� �h �. _ ' c��l �� f�c�vi�. . <br /> CONTACT INFORMATION <br /> OWNER NAME: �� �� jV��k�n�;� TENANT NAME(If Commercial): <br /> OWNER MAILWG ADDRESS: sTREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �C�.v� Vv� �j ^�t'�L L(,L <br /> CONTRACTOR ADDRESS: sTReer , � ' I I L�� � `"}-- <br /> arv C �'"� - �,v�✓� sTATE (i.;�- ziP ' ,��... <br /> CONTRACTOR PHONE: -)t�s - U ���.��' CONTRACTOR EMAIL: t iJC.I V��U �'���.}�C .�. LL�- �, ��'vvc:,l��;;�� <br /> CONTRACTOR LIC.#(REQUIRED): �, u�;;v�� � �� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �� ��"J <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ���� . �� _n7�7; <br /> �7• ,, � <br /> l�� ��(�:C�`��i,�-� CONTACT EMAIL: <br /> AGREEMENT:T 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 <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 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Evereft Official Use Only <br /> FEE <br /> � � � � �� <br /> . PERMIT# <br /> �.,� - �,-�a -r � E � �D ' l 5Z <br /> Owner/Au hor' Agent Signature Date (Revised 10/12/2015) <br />