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tLECTRICAL PERMIT AP�LICATION <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: l� �L� '� � ,(, <br /> BUILDING AREA(if residential, new construction, remodel, or addition)/,,:��,� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: 2�j <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ��\,�, <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES Q�] NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �•,� �.,��0c�`��p� % ' �U 1r� .1,�"'�(� �,�J' �r'.�V`�L, � %�/V`;�i <br /> � <br /> CONTACT INFORMATION <br /> OWNER NAME: `�'�- �'�\�r� , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer ��� 1 ���Q-t� �G, <br /> / ( /l�� �i�G� CITY V �/ / / STATE ZIP �p�n. <br /> OWNER PHONE: `-`� 7'j�"�� "\O�n'� OWNER EMAIL: <br /> CONTRACTORNAME: J��`(� �� ���L- <br /> CONTRACTOR ADDRESS: sTReer � (7`� � ' j; <br /> M I ����Y ,V�� STATE � � �l ZIP <br /> CONTRACTOR PHONE: �LS 2G� S�g I CONTRACTOR EMAIL: (i',`� i/J !`��I�P[.�y,,� � �%✓IS'/f/ �� <br /> CONTRACTOR LIC.#(REQUIRED): �V 5���� J� � CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O5�� � <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2,� G �� 5 7� ' <br /> Cv�� (,� ��/� CONTACT EMAIL: <br /> AGREEMENT. T hereby certify thaf 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 regulafing consfruction or the performance of construction. That I am authorized by the owner of this property to pertorm the work for whicir applicafion is made and I <br /> comply wifh the State Confractors Law 18.27 RCW and 296.200 WqC. <br /> City of Everett Official Use Only <br /> FEE <br /> /� �,��U c% <br /> a <br /> _ f,n <br /> PERMIT# <br /> � c ( <br /> � ��, � � �� E � ; � _ �:�� <br /> � I � � l � <br /> ner/Authorize Agent Signature Date (Revised 10/12/7_015) <br />