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�CTRICAL PERMIT AP�ICATION <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: �JI I �v. !.� Oa <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 9j� 73� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: f�'COMMERCIAL <br /> USE OF BUILDING: �slJ L�yNtt y" <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ S�, ��y R tJ� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? �YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /�/� rc � c- r tf �o <br /> r � <br /> CONTACT INFORMATION <br /> OWNER NAME: W Sc,� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr /�D, �v J� G�.3�/I <br /> CITY �U II/I1QN STATE (N /7 ZIP �p��/ <br /> OWNER PHONE: 509-�,�,�- yy,37 OWNER EMAIL: <br /> CONTRACTOR NAME: GOn/VCY /N'�' �C�lj ,�/d�0 /CI <br /> CONTRACTOR ADDRESS: srREEr SD SjJ q f�' �✓c- S. <br /> CITY /C e�✓f�� STATE ��! 7_IP /(J�J 7 <br /> CONTRACTOR PHONE: S�ZS-Z6 y- 936G CONTRACTOR EMAIL: /��-,v. ,�4��Y � Lti � . Go <br /> CONTRACTOR LIC.#(REQUIRED): CON Ut T�. 9 9 rJN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �yZ�O 6Z <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: l�ZS.�Z6 t�_ 93LG <br /> �e^� "�a ��� CONTACT EMAIL: / <br /> /�e.✓. Q�ey �Ld.✓Yc't i.✓7j.C o/t� <br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of aws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> loca/law regulating construction or the performance of construction That 1 am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the Stafe Contractors Law 18.27 RCW and 296.200 WAC <br /> City of Everett Official Use Only <br /> , FEE <br /> �� �� f� C/ <br /> l <br /> PERMIT# <br /> .��,�. s�D i� E �����'���1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) - ` � <br />