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� � <br /> ELECTRICAL PERMIT APPLICATION <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: � ,- 4� �� (�� 'C � T"� �1 " �- ��,3 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) ,,� C�C�C� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED `C�SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: S!ti� I_ 'y �.�/r!�✓ �-�y� , ti,:i 4 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /�J � (��(j <br /> NUMBER OF DEVICES (if low volta e): A.� <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT# (if applicable): � <br /> DESCRIPTION OF WORK: <br /> 1 `ti i,+- l�fi � ,�J�;�0�'�.A�J `L �.��-�("f'—\�./� t_. ,5 <`r'�� �`z�.- <br /> CONTACT INFORMATION <br /> OWNER NAME: � ',�!�15"`T� 'Y}`Z �. ��(�7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer � y—� , (�� � <br /> CITY �j��e-�-� STATE �J.J`� ZIP��� ��.)� <br /> OWNER PHONE: �(=�Q'� �v — 6 j j 7 OWNER EMAIL: C : �ti,��?}l� . �G�ps�� C,IY�'�i �- - Lc�:�"l <br /> CONTRACTOR NAME: ^ (,✓;l.i � <br /> CONTRACTOR ADDRESS: sTREer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: �pWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �U �, � �-�'�r;.— ��� J <br /> 1.��'('�j�v'Ci% l'f�L r� I�%C�J4CS CONTACT EMAIL: C : l�ilz�i� , �:;c��� l��'_`� �.—�M A r _ ����� <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All p�ovisions 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 cance/the provisions of any other state or <br /> local law regulating construction or the pertormance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �� �s <br /> PERMIT# <br /> �� -� - � �� � � E ��-� - d �- <br /> ;-�- <br /> O ner/Authorized Agent Sign Date (Revrsed 10/12/2015) <br />