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� • <br /> ELECTRICAL PERII'4tf�T APPLICATION <br /> CITY�F 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 /> PRiDJECT SITE INFQRMATI(�N <br /> PROJECT ADDRESS; �j(�� �{L�p�„} �k -�,,, <br /> BUILDING AREA 1iF residential, new construction,rernotlei, or addition) SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS ❑CQMMERCIAL <br /> U5E OF BUILDING: <br /> EC.EGTRIC�IL AP'PLIC,liTfQt+1�tN�l'�RMA�TIla►M <br /> CONTRACT PRICE OF WORK: $ (� ,E'° <br /> NUMBER OF DEVICES if low volt2 e ; <br /> FlRE ALARM? �YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if a li�able ° <br /> DESCRIPTION OF WORK: h � {;r"-,,,�.� <br /> CONT�ICT IN�ORt'VI,�"t'�QN <br /> OWNER NAME: �("'�ti,(,f �,�'"1 TENANT NAME If Commerciai}: <br /> OWNER MAILING A�DRESS: srREEr ,�,�.Q �(�' �,j (,�, �,, <br /> ... �m GsV .. S�TATE �,,.�� Z'�.P i GJ I�� � . <br /> OWNER PHONE: �.ZS �-� � � � QWNER EMAIL: <br /> CONTRAC'TC7R NAME: �n <br /> C{7MTRACTOR ADDRES5: srREET ' � �Q(� <br /> cirr srare /.�- ziP � ZC'� <br /> CONTRACTOR PHONE. ,� �� CONTRACTOR EMAIL: , �` yN <br /> CONTRACTOR LIC.#{RE�UiR�D}:��e � �(,�� CITY aF EVERETT BUSINESS LIC.#(f2EC1UIFE[7): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CC7N7ACT PHONE: �� ��G� D i� <br /> � `��1�I e CONTACT EMAIL• �� �� f� ht'.�'1 CQrn <br /> AGREEMENT.I hereby certily that i have read and examined this applica!!on and know the same to be true and correct. All provisions of laws and o�dinances govemrng this iype <br /> of work will be completed whether speci(ed herein or not. The granfing of a permit does not presume to give authorily Io v/olate or cancel the provrsions of any other sPate or <br /> locai law regulating consbucfion or fhe peAormance of construction. That 1 am authorized by the owner oi this property fo pertorm fho work for which applicetion is made and 1 <br /> compty w1�h fhe 5fate Conbactors Law 18.27 RC W and 296.200 WAC. <br /> City ol Eve�ett Officlal Use Only <br /> PERMIT# <br /> � `�kz���a.u��� - _ � • ! -17 E �� b � ' (��� <br /> OwnarlAuthoriz¢d Agent Sign�ture Dale (Revised 9/23/2016J <br />