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WECTRICAL PERMIT AI&LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ; 1 �� ter,: 7_'n 8 <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: $ I 66 <br /> NUMBER OF DEVICES (if low voltage): / <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): >�> <br /> DESCRIPTION OF WORK: �� � ,1�- ���� ��y� r d�Q�-� ��•^�f L""= <br /> t�L:� K_' v L�.S6�R't�3'✓\ C� '� C.�r` C.. 01tiCt'"^tom-'' <br /> CONTACT INFORMATION <br /> OWNER NAME: , u'4iV�lLl 6 - <br /> kn ILC-TENANT NAME(If Commercial): <br /> 7 <br /> OWNER MAILING ADDRESS: STREET 6 l/ po 'k .y <br /> CIN g� [ `v u. 51-ATE `..•t.C' � ZIP QVQ� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � � �' �c�v\ ���T e- ,,c= L„A_� <br /> CONTRACTOR ADDRESS: STREET 4n-r Z 4n 'C4 �a— <br /> CITY J I-J `Q !',� �+1 /STATE C�+ "4�1 ZIP <br /> CONTRACTOR PHONE: 264- `- � T CONTRACTOR EMAIL: j eft .ee:tv-t1� M�. <br /> CONTRACTOR LIC.#(REQUIRED): !j Tw=j%t� r i14 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER L'. ,CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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 consiruction 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 i <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> i { V <br /> PERMIT# <br /> Owner/Authorized Age Signature Date (Revised 10112/2015) <br />