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0 0 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION n' <br /> PROJECT ADDRESS: f n f G'G r vl/ii C (SL'e�Zc 77 (,t/!� '7�4- <br /> BUILDING AREA(if residential, new construction, remodel, or addition) Z r � 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: $ �n� cfU <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 2_0V 1�t_j/_2 -5L- <br /> CONTACT <br /> 5-CONTACT INFORMATION <br /> OWNER NAME: f 3 l (✓� Zl`' ✓1! TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET "L_ I,///(-&I/t/oIq <br /> v�i JJ^� <br /> CITY STATE ZIP ZV <br /> OWNER PHONE: 206- -2``l' z OWNER EMAIL: <br /> CONTRACTOR NAME: 1 t- TU H c��T_/Z / L <br /> CONTRACTOR ADDRESS: STREET 7 SGT l ESL 136&10 <br /> CITY L =�- STATE (/f//T ZIP 97Z'.q 7 <br /> CONTRACTOR PHONE: �Z�-3 - CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): Z/ �`-Lf���� (} CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT <br /> NAME: CONTACT PHONE: L1Zj- -3a"7-qO/ <br /> IIlZ126�i�/vUZi�b( CONTACT EMAIL: 160tJ/L-r�✓4Z f 47/ 4 v`l/&;V' GCn'I <br /> AGREEMENT.1 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 type <br /> 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/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 /> City of Everett Official Use Only <br /> PERMIT# <br /> Qw6dAeKorized Age Signature bate (Revised 9/23/2016) <br />