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� � <br /> E�ECTRICAL PERMIT J4PPLICATIC3N <br /> ClTY OF EVERETT PERMfT SERVICES <br /> 3200 CEDAR STREET, EVERETT,W!A 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 � (E}everetteps@everettwa.gov� www.evere#trr+ra.govlpermits <br /> PRCIJEGT SIT� INFORMATION <br /> PROJECT A�DRESS: �D� cI �r� <br /> BUILDiNG AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: �SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> U5E�F BUILDING: �—r �Sl <br /> ELECTRI�AL APPLfCAT10N INFORMATION <br /> CONTRACT PRICE OF WORK: � y�� <br /> NUMBER OF �EVICES if low volta e : <br /> FIRE ALARM7 ❑YES ❑NO <br /> ASSOGIATED BUILDING PERMIT# if a licable: <br /> DESCRtPTION OF WORK; Z �?�/n. D.x�I T n/ N2 .P� d2 <br /> CONTACT' INPORMATtON <br /> OWNER NAME: � � C rr'e7�1 TENANT FtAME If Gommerclal : <br /> OWNER MAILING ADDRESS: srReer 6 7�7 e�Jor� 2c'P <br /> ,,�!/� 7,�,n <br /> CITY �,.'j�.2� STATE vy'�� 7JP (��`Ll� <br /> OWNER PHONE: qWNER EMAIL: <br /> CQNTRACTOR NAME; WMNtt,�/S� �+� <br /> CONTRACTOR ADDRE55: srReEr �C S� C�"2A/1 <br /> CIN 1�_�i^J STATE �f� TJP �G'�J 7 <br /> CONTRACTORP�{ONE: Z�'L77�S��I3 COHTRACTOREMAIL: ���W1�SS(� CcykM� .��CUM <br /> C�NTRAGTOR LIG.#(REQUiRED}:C;/�v�,m// `�.�"-s� I �ITY OF EVERETT eUSINESS LIC.#(REQUIREa}: <br /> PRIMARY CONTAGT: ❑OWNER �CONTRACTOR �OTHER(Please Specify} <br /> CQM7ACT NAHIE. C�I�tTACT PHC}NE: � �,,� ��"7� .��t/s <br /> �iQ(� ��5�'''" CONTACTEMAIL; Nr G S.Ct11v <br /> �A. �i�S.fUr�-� �✓�^r�,„v <br /> AGREEMENT.�T heretay Certi(y tflat l Aave�ead and axamrrsed tArs appiicafron and krre7w fhe same to be true and crorreci. Ait provisians oflacvs and or�u�ances goveming�his <br /> rype of work wilt be cOmpfeted whether spec��d herein or nof. The grantfng ot a permit does not presume to grve auUrwity to violate nr cance�the provisrons of any other state or <br /> /oral Iaw regulating ronsfn�clron or the performance o�constrvctro� That 1 am authwrzed by the owrrer ol this propeRy fe perlorm!he wais!or which application is made and I <br /> camply wrth the State ContraCfas Law 19.27 RCIN and 29S.2D0 WAC. <br /> City of Everett Officia!Use Only <br /> FEE <br /> `.�� '� � <br /> ^.....�..�.� <br /> PERMIT# <br /> a <br /> 1 �...- /�%r � E ���� � ��� <br /> OwnerlAuthor gent Stgnature Rate (Revised?0/i270?5) <br />