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�LECTRICAL PERMIT A�LICATION <br /> Ey 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: �L3 (3 ������h �2F1 �v� <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX F�MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Sc�S` ��= <br /> NUMBER OF DEVICES if low volta e): <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT#(if a licable : <br /> DESCRIPTION OF WORK: `d�f-r�,1 a���i� CT�ec�-►'� ►c+ F-I�-,a T �.rv�P <br /> CONTACT INFORMATION <br /> OWNER NAME: � ��F� kZ�pl1�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer 2 �)� �-���r+�+�-� AVE <br /> aTv � <br /> FVF1L{,�T"' STATE �,U�1 ZIP I�7(,'' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ��,..So�.2t''� �-�k���� <br /> CONTRACTORADDRESS: srHEeT IZ .3��� �6�L'tiik�i �� <br /> CIN �L-�-11;..Y�1C,� STATE �--Ui� ZIP ��•3� <br /> CONTRACTOR PHONE: �Ec- - 3) - G i l CONTRACTOR EMAIL:-T�I�f.�c Yh�-��C�(�_C�r��- ��-� <br /> CONTRACTOR LIC.#(REqUIRED): VF}Nt�EE-�l`S`t50L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): � � <br /> PRIMARY CONTACT: '�-OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ���, 3i�- G►z� <br /> I �l ��+-- �p;`1-x�j�� CONTACT EMA1L: <br /> AGREEMENT.�I hereby cerfify that 1 have read and examined this application and know the same to be frue and correct. Alt provisions of laws and ordinances goveming this type <br /> of work wilf be completed whether spec�ed herein or noi. The granting of a perrnrt dces not presume to give authoriry fo violate or cance!the provisions of any other state or <br /> local!ew regulating construction or fhe perforrnance of construction. That I am euthorized 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 Official Use Only <br /> PERMIT# <br /> L_ �---- .���,��-, E j���, �2� <br /> Owner/ horized Agent Signature Date (Revised 9/23/2016) <br />