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�LE�TRI�A� �EF�.tVIIT AP•L1��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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: -� ,3 � � �; j f}(�� <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 BUILDWG: ��Q (L /-{ L� <br /> � <br /> ELEC'FRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � �Co V <br /> NUMBER OF DEVICES (if low voltage�}- <br /> FIRE ALARM? ❑YES �[� NO � <br /> ASSOCIATED BUILDING PERMIT#(i�applicable1:�� <br /> DESCRIPTION OF WORK: �,f�� � ' z d-� C j/��u� �-$ �o,� �)�F�/� ((pl=Q j 2�,"'�� <br /> CONTACT INFORMATION <br /> OWNER NAME: / % �����. T .�_� TENANT NAME(!f Commercial): �� � �) � <br /> OWNER MAILING ADDRESS: sTReET `c�n LLJ �j�/ l��`}Ki �./} �r S ff j�' i,J „N� <br /> Cm ��E LL F V U� STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> _ _ . .__ . _ _ . <br /> CONTRACTOR NAME: D, C7. p_ T/;'� ��; L� �i�`� l�'� <br /> CONTRACTOR ADDRESS: sTaeer ,3 3 Z 2 3� � S% 5�U <br /> CIN /U✓�����CJVYJ STATE ZIP (�+ <br /> CONTRACTOR PHONE:1�6 �.S 3 `� �.� CONTRACTOR EMAIL: �C � '�C Fi ( � �$u-r��'S" �• ti�/=% <br /> CONTRACTOR LIC.#(REQUIRED): ,,D C 1 L.j C .� � C O ./� C CITY OF EVERETT BUSINESS LIC.#(REQUIRED)t�.�17 Z.�O% <br /> . ._-._., ___.- :....,:. _...:. . . ........_ . ._::,...,. _,....... ..., ,._.:.:. ..:_,_... . . ..:...:.. _.:., _ _._ ._ ,,,... _...... _.... <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) "� _ <br /> CONTACT NAME: CONTACT PHONE: �9�� � <br /> ,��(�� �� T�'-� �j o i✓ CONTACT EMAIL: <br /> AGREEMENT.�T hereby certify that l have read and examined this application and know the same to be frue and correct. AlI provisions of laws and ordinances governing this <br /> type of wo�k will be comp/eted whether specified herein or nof. The granfing of a permif does nof presume to give authority fo violate or cancel the provisions of any other state or <br /> local law regulating consfruction or the performance of construcfion. That I am aufhorized by the owner of this property to perform the work for which app/ication is made and 1 <br /> comp/y with the State Confractors Law 1827 RCW and 296.200 WAC. <br /> City of Everett Official Use On/y <br /> FEE <br /> � � ' � O <br /> PERMIT# <br /> ��,-e- E �,�-05 - �S� <br /> , Owner/Aufhorized Agent Signature Date (Revised 10/92/2015) <br />