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�LECTRI�AI� ��RtVI1T �=: :�LIC�aT'101�1 <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: �� � � �/c-��C%� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX I�MULTI-FAMILY-#OF UNITS: � ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ' �� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: G.� c9u.}�,�' L? �- <br /> CONTACT INFORMATION <br /> OWNER NAME: �uL ��-�� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sal�� G�� '� y � �� lJ <br /> CI7Y (.y�- C/1 ',:�_ STATE �� ZIP �� � �� 7 <br /> OWNER PHONE: 3 ^ - 7 7G - ,3� OWNER EMAIL:;�LI S�v� • C � o� �' �tc� ��tc i �v 'Yj'{ <br /> CONTRACTOR NAME: Q �{2 _�— <br /> CONTRACTOR ADDRESS: s-rReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): �C�i'�2C�'� CITY OF EVERETT BUSWESS LIC.#(REQUIRED): <br /> .._,__.._ ,.._..: ,.,.:.:,_ _. ............ . ......__.. � _,.._.: . .,_ _._. ,..:._ _,._ . _. _ .,,:_ . ,.._,.,.. <br /> _,,..., _ __ <br /> PRIMARY CONTACT: ft�OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ��� , G- �Z�a� <br /> � " L ��lr�� CONTACT EMAIL• L� S",-? c,ry�G✓�r- :,.��cv��:�.�ro<�� ' �� <br /> �•f��v <br /> AGREEMENT.�T here6y certify that I have read and examined this application and know the same to be true and correcf. Al1 provisions of laws and ordinances governing this <br /> type of work will 6e completed whether specified herein or not. The granting of a permit does not presume to give authority fo violate or cancel the provisions of any other state or <br /> loca//aw regulating consfruction or the performance of constructron. That I am authorized 6y the owner of this property to pertorm the work for which application is made and l <br /> comply with the Sfate Confractors Law 98.27 RCW and 296.200 WAC. <br /> City of Evereft Officral Use Only <br /> FEE <br /> '�" � � �.� <br /> � <br /> � PERMIT# <br /> r � <br /> �-� 2 ��_,� �--- U� -�l - ��� �� I��2-�� <br /> Owner/Aufhorized Agent Signature Date (Revised 10/12/2015) <br />