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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 /> PROJECTADDRESS: '-L,��� �C-{.��,t.-r-l�fr `�V�,� <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: `�l SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ JOr) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: •�'IZ�� t � S� � 11(?C1�i._--i'`..,' � �.1�- ti� ' <br /> _ � <br /> CONTACT INFORMATION <br /> OWNER NAME: � k' "���i�ti G TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRFFT �GnU.� � �X--���� C�l,�i�-� <br /> , /� <br /> CITY ��V � : '�..�',�� STATE LC.� ZIP G�I �`, / <br /> OWNER PHONE: ZC�,G' -��� ` '�I��N OWNER EMAIL: <br /> CONTRACTOR NAME: �� � � �ll,� � �' �YY�- -� -%-� '�-��J�.��G�(�S <br /> CONTRACTORADDRESS: srREEr ��� ��- I��I p <br /> CITY �����-" ��L����� STATE \1�� ZIP ��U���' <br /> CONTRACTOR PHONE: �C)' �1��� %�Z-�=' CONTRACTOR EMAIL: ' ��Gf�"'--�-� �GL � . 'C�� <br /> c > -�'sC'-�k{(:�� =� ' F� ( ) C� � r—�� <br /> CONTRACTOR LIC.#REQUIRED: 7,_� CITY OF EVERETT BUSINESS LIC.#REQUIRED : �'�'��f_'� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: "�(��(,� .�yi�S `�SZ�L.� <br /> � ' (� � �'�,�'��1 CONTACT EMAIL: � � • � �, � �'�� � ���' � � �� <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be tr e and correct. All provision f laws and ordinanceS verning this type <br /> 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 1 am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Cont�actors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> i <br /> / PERMIT# <br /> i i � io �� E �� I —�� <br /> OwnerlAut orized Agent Signature Date (Revised 9/23/2016) <br /> � <br />