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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 INFORMATION <br /> PROJECT ADDRESS: ( ()l mq(( WLl J j <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: Vpp4 :-�G�'e"X <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ f oc",CIO, <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES O <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: AAA C1rCU1 v' 70 Avg2 Z, �t O y" -�A <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): Stxn­�P_ <br /> OWNER MAULING ADDRESS: STREET 60-1 SG E..4 M&i(/ ) <Ac 7j A- <br /> KIP-,elt CITY STATE ZIP <br /> OWNER PHONE: -4Z5- U j• 0'7-3 i OWNER EMAIL: 0.�Ce\ Q�`� C"lwlai � .LO✓✓1 <br /> CONTRACTOR NAME: 1<4 Co <br /> CONTRACTOR ADDRESS: STREET/?j fDO Jc f�iuJ 7th O PM6 <br /> CITY N [I STATE ZIP 960 1 Z <br /> CONTRACTOR PHONE: L{z;i' 7j - elo-L CONTRACTOR EMAIL: als (C 4 ✓ !, ;tti <br /> CONTRACTOR LIC.#(REQUIRED): k�L�IG CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(;-y tj <br /> PRIMARY CONTACT: WNER '9CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: l�15 (�� 17 <br /> AGREEMENT:T hereby certify that/have read and examined this application and know the same to be true anj 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/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 /> Al,, , <br /> PERMIT# <br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br />