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��...,�,..�',.- <br /> ELECTRICAL PERMlT APPLICATION �U�yr <br /> CITY OF EVERETT PERMlT'SERVICES <br /> 32Q0 CEDAR STREET, EVERETT,WA 98201 ������f�� <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gav � www.evereitwa.gov/permits <br /> PROJECT SITE {NPBRMATIt?N <br /> PROJECT ADdRES5: p�°�-��`e� �_��..`�'lY~�C�\,~� <br /> BUILDING Al2EA(if residentia(,new construction,remodel,or addition) SF <br /> BUILDING 7YPE: ❑ SFR-DETACHED ❑SFR-ATTACHEQ � DUP�EX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUIL�ING: `,...��i'�.� ,.,-_ ._,� <br /> !�ELECTRICALIAPPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $�� � .,�C;; <br /> NUMBER OF DEVICES (if low vo ta e}: <br /> FIRE ALARM? ❑YE5 � NO � <br /> ASSOCIATEg SUILDING PERMIT#�`�ifi-a le : <br /> DESCRIPTIOhI OF WORK: � �,: C '�� � � ,``�, �,. r <br /> (/V.-�n/�. <br /> CONTAGT INFORMATtON <br /> OWNER NAME: ��� TENANT NAME(If Commerciai): <br /> OWNEF2 MAILING ADDRESS: srrteer � �.%;,�, �j� �{-�, �y�y�' <br /> cirv --• ` y'�Q.., STA7E U�.J�'t ziP� ..,��j R <br /> OWNERPHONE: l�;—`- '�� - � {G.� OWNEREMAIL• ;g UCt-' Y���' � 'C�'CY1 ` E✓ � <br /> CON7RACTOR NAME: �' � `�� ' �,.,'�Y� 1,.�( ��t,n�� .�� <br /> CONTRACTOR ADDftESS: srREer � �( U��� _ �� ��\ <br /> CIN :,�� ��'�� STATE !V�};' ZIF �P� �- <br /> � E <br /> CONTRACTOR PHONE: � _ �. CONTRACTOR EMAIL:�.�1�1C,S�. �1����' "',�C� [�� , °j `. � <br /> CONTRACTOR LIC.#(REQUIRED); �°.�?'�� , t, C: ? � ' � CITY O�EVERETT BUSINESS UC.#(REQUIRE'): � �, ��,� <br /> PRIMARY CONTACT: CI OWNER CONTRACTOR �OTHER(Please Specify} _ ___ <br /> CONTACT NAME: CONTACT PHONE: '���`~,.. " ,_. '�-.,�., ---'� <br /> '��� :_..3�'�`C`'V�1"�$� CONTACT EMAtI.:�.C''��(� �t.:`6���`�' ' tC' ��� � � . �(`3` <br /> AGREEMENT:T hereby cartify that I have�ead and examrned this app(ication artd know�he sa�i�e to be true and corraGf. Al!provisions pf laws and ordinances goveming this <br /> type of work wil!be completed whethe�specified herein or not. The graiting of a permit does nol presurne to give authorrfy to violate or canceJ the provrs;ons of any ofher sfate or <br /> loca!!aw regulating earrstruction or the pedoimance ol construction. That 1 am au2horized by the owner ot this property to perform the work for which application is made and! <br /> compty with Ih�State Ca�tractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Ofticial Use Only <br /> FEE <br /> � � /� <br /> PERMIT# <br /> `` f� � r� E ��05 - 12,� <br /> �� �., <br /> . .� t ` <br /> Ownerl uthorized Agent Si ature ate {Revised 10/12/2015) <br />