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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 /> PROJECT ADDRESS�/ U�J r f�.,� ��,s��" � �� -- <br /> BUILDING AREA(if residential, new construction, remodel,o ddition) � � SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATfACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ R �.• L.` <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if ap licable : <br /> DESCRIPTION OF WORK: �V `l;G._."..✓�"�� l � V �, `�-� �`�l'� <br /> t t �� �. C <br /> CONTACT INFORMATION <br /> OWNER NAME:��,%��V'l�"'1G..- �,��' �l `�' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREET L�j� Y ��r "� � <br /> CITY ^ �V '�� �� STATE � v ' ` ZIP � �Z/�� <br /> OWNER PHONE: L� '' �j — L-'I� �� OWNER EMAIL: �1 � �"� <br /> CONTRACTOR NAME: ��t�-V1J�•-' <br /> CONTRACTOR ADDRESS: sTaeer � I ��.u� i'�/�� � � � <br /> CITY �� ,"1/�% V�"C. ����V� `"^-- TATE � ' ZIP �, ��. ,� <br /> CONTRACTOR PHONE: Z� � I —I l�� CONTRACTOR EMAIL:� ' '"� �� �L,._�VL'� �✓�' <br /> CONTRACTOR LIC.#(REQUIRED): � ,, ��� _; �°"l r V l CITY OF EVERETT BUSINESS LIC.#(REQUIRED): U J�� 1 V <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER (Please Specify) <br /> CONT CT NAME: CONTACT PHONE:C— �, I <br /> ���'� ' I�'L I�Lt�`� ��l�� I �' CONTACT EMAIL: i � (J ✓ ��. � yl� �j 1 ,G <br /> AGREEMENT:T here6y certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permii does not presume to give auihority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by ihe owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �: �� °o <br /> PERMIT# <br /> , /`�� <br /> ��� m � - <br /> ' ��- �"Z� l I'� E 7� _ <br /> , ___ ,,� � <br /> Owner/ onzed Agent Signatu Date (Revised 10/12/2015) <br /> �-------- _/ <br /> \ <br />