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� � � � <br /> ELE T'RI �4� P�F�.MIT i�PPLI �4TION <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: �l� C (/��� �rL�C'�� li✓`'? <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFI�-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: .�COMMERCIAL <br /> USE OF BUILDING: ti/,� - � (,�n� • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ' U C� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES �lVO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /1/ <br /> f <br /> DESCRIPTION OF WQ�RK: - .� , �;I rfi� l CGrp�E�d'� �'iZr , <br /> CONTACT INFORMATION <br /> / � � 3 . <br /> OWNER NAME: 1� � S,�'r[C-' SE- �l'7 ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rREET <br /> CIN STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> _ . _.. . _ _ . ' _ _. <br /> ( : , <br /> CONTRACTOR NAME: i.)✓1 nPG+i�I C� ' Y� C <br /> CONTRACTOR ADDRESS: sTReeT �I S��-� I D�� ✓ <br /> �/ J , � �, <br /> CI'IY �I ij�-�j l� STATE V`� � ZIP <br /> CONTRACTOR PHONE: �� '����%�� � ' CONTRACTOR EMAIL: SO<�h � f L ✓��� � ✓' S�,G� • � U <br /> CONTRACTOR LIC.#(REc�UIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> .. __ ... . . ._ .. <br /> PRIMARY CONTACT: ❑OWNER G�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a� .. ���'�-, ��'7 ' � <br /> ��p SO�/I�G'L' CONTACT EMAI L: �O�'1 - I,p , /, C �7 ;Aij S'.^'J; c. d/n� <br /> AGREEMENT.'T hereby certify that l have read and examined fhis application and know the same fo be true and correct All provisions of/aws and ordinances governing this <br /> fype of work will be completed v��hether 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 consfruction. That I am authorized by the owner of this properfy to perform the work for which application rs made and I <br /> comply wifh the Stafe Confractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use On/y <br /> FEE <br /> � � � � v <br /> PERMIT# <br /> �'1/ �� -- �.�-1� E ( (�( - 1�`� <br /> Owner/Authorized Agent Signa Date (Revised 10/12/2095) <br />