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�EC;TRICi4L PERNIIT AP�IC�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 /> ; <br /> PROJECT SITE INFORMATION ? <br /> PROJECT ADDRESS: �!C �� � ��'n�,.�c°� I�C9C?� <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 /> USE OF BUILDING: �� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z Z V,Z�,. U�-' <br /> NUMBER OF DEVICES (if low voltage): N� <br /> FIRE ALARM? ❑ YES - NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): �� <br /> DESCRIPTION OF WORK: �y� K� ���'t� � L ��-� �� � ,,., <br /> CONTACT INFORMATION <br /> OWNER NAME: �/1,)'11 I��� �YL^�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReEr � "�0� , e' Z 5 :��yd� <br /> CITY � �� L �'�" STATE ZIP �CJ �O� <br /> OWNER PHONE: � Z�� `1O S 3Sl�/ OWNER EMAIL; � �••T ��Z rj7 ' �%'i'� 1�1SC•� � <br /> _ _ __.. . _ _ <br /> � <br /> CONTRACTOR NAME: ' L• ' <br /> CONTRACTOR ADDRESS: sTaeEr / �l� mY�Y/� ��G,1��� L l �'�'� j�s <br /> CITY /��1/ STATE �' ZIP l0 �G'J <br /> CONTRACTOR PHONE: L ���" C� 7 - (��J� CONTRACTOR EMAIL: SCe� ' e�l�'� sL• C�PiyL <br /> CONTRACTOR LIC.#(REQUIRED): `/+ :L � /�/ CITY OF EVERETT BUSWESS LIC.#(REQUIRED): ���3 S�z <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: i�"Z J^ 3 �"�— 7(/J;,��' <br /> S�,, � l rf� CONTACT EMAIL:��- � �1�/��,' �� , �/yy� <br /> AGREEMENT:T he�eby certify that 1 have read and examined fhis application and know the same to be true and co�rect. All provisions of laws and ordinances goveming this <br /> type of work will be complefed whefher specified herein or not. The granfing of a permit does not presume to give authoniy to vrolate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authonzed by fhe owner of this property to perform the work for which app/ication is made and 1 <br /> comp/y wifh the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> , <br /> ��,� . � S <br /> PERMIT# <br /> * � / � � `� E ��-O� -D� � <br /> Owner/Aut orized gent Signature Dat (Revised 10/12/2015) <br />