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CTRICAL PERMIT APOLICATION <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 I www.everettwa.gov/permits <br /> PROJECT SITE INF RMATION <br /> PROJECT ADDRESS: >`C=✓� "Va:,�} �%Q/c�'c�'IC-1 GL%/7 � �"C�/ <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: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ j - ZS <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES _9' <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRIPTION OF W RK: <br /> dr d CONTACT INFORMATION <br /> /Vt <br /> OWNER NAME: TZn�Y �-) ()�_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CRY �-f�r � STATE 44/4 ZIP 1 <br /> OWNER PHONE: O G OWNER EMAIL: '!. Cc» <br /> CONTRACTOR NAME: Anllc*, L�( <br /> CONTRACTOR ADDRESS: STREET / 7 - G J�� FV <br /> CITY — STATE A_ ZIP <br /> 1 7 <br /> CONTRACTOR PHONE: — 7 L �)e ONT/RnACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):I" `+L 1 c X C CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACTrNAME: CONTACT PHONE: `� — 7 / __ <br /> t�•� I "-�� CONTACT EMAIL: ��, �;�5 Cii U✓IL - C ,,,v`� <br /> AGREEMENT:Thereby certify that/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 I am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Oficial Use Only <br /> FEE <br /> PERMIT# <br /> Owner/AuthorizeA Agent Signature Date (Revised 10/12/2015) <br /> 1 <br />