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�CTRICAL PERMIT AP�_ICATION <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: ���•�� �L��C, ; �p'� L����t� J,.(� ` I,(�� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETf�CHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: _._ �COMMf:f�Gnl <br /> USE OF BUILQING: � -�'� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2 CC! <br /> NUMBER OF QEVICES if low volta e : <br /> FIRE ALARM? ❑ YES NO <br /> ASSOCIATED BUILQING PERMIT# (if applicable): <br /> D�SCRIPTION OF WORK: �� U(tl-�' . ���j `i (�C �'I,'��Y✓d�l �` "t:4� <br /> � <br /> CONTACT INFORMATION <br /> OWNER NAME: �- �. -��pF`"� ���j L.L..�, TENANT NAME(If Commercial): L-Ci '' j�`('�� ;��L� Gl���') <br /> OWNER MAILING ADDRESS: s�R��r )� ,�? �� (,'' �L'C( j� <br /> CITY �-�,�IC.,LyL'�. 5�A1�f' � ".� LIP C1liC.-L��I <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C�I�N�, �C�, j C atJiCl �� Ii nC <br /> CONTRACTOR ADDRESS: srR�E r � �c'X �Zf) ~� <br /> CITY S�IAI�E- /IF� C�v v� <br /> CONTRACTOR PHONE: -l2�- C1Z�' IZ�(�j CONTRACTOR EMAIL• C�/i�lyl w C i�)1'�'F�V,���: CU <br /> I� C � <br /> CONTRACTOR LIC.#(REQUIRED): ��' r��,Fy� CITY OF EVER�TT BUSINESS LIC. Ec�UII�ED): <br /> PRIMARY CONTACT: ❑ OWNFR [�CCONTRACTOR ❑ U1 HF_R F lease S ecif --a_-__._�.___—---`�� <br /> �' P Y) --__._ ___ _ _ __ __ _-- _ <br /> CONTACT NAME: CONTACT PHONE: LtZ�, ��,Z,/'/Z�I� <br /> ��J �-r'�' jn ,��lC"C',�L��r`� CONTACT EMAIL: ��a,r�U� C� C I'+��' N����L�> Ll��,'L1 <br /> AGFZE[MFNT 1'hereby certify that 1 have read and examined this application and know the same fo be true and correcL Flll provisions of laws and ordinances qovcrniny this <br /> rype oI work will be completed whether specified herein or noL The granting of a permit does not presume to give authority b violate or cancel the provisions of any other.slate:�- <br /> local law reyulating constniction o�the performance of construction. lhat I am authorized by the owner of this property to perform the work for which application is madc arici I <br /> comply with the Statc Contractors l.aw 18.7.7 F�CW and 296.200 WAC. <br /> City of E:verett Official Usc Only <br /> FEE <br /> ��. ---- <br /> �) _ <br /> �_ <br /> ' PERMIT # <br /> E � �,���.�� � ��-��-�� E a ��� � Q <br /> Owner uthor' ed gent Signature Date (Ftevised 10/12/2015) <br />