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�CTRICAL PERMIT AP�CATION <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: �,;. I � '���Il ''I u\ ��;��j�- <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 /> LEC'T�ICAL AP'�LICATION INFORMATION <br /> CONTRACT PRICE OF WORK� $ �-�, � <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> ,� i <br /> `Lv'�1"�J- -T� C �-}- J � l,V'"C�V l�C' i 1 � <br /> CONTACT INFORMATION <br /> OWNER NAME: .—` � ��—tGLC:IC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT ��Z� ' yI , L� JV � <br /> cirr �{�1� ,�� � \�'�- STATE W�'�� zia � ' � � <br /> OWNER PHONE: '�}L�'ZY� Z`�Z� OWNER EMAIL: �C1�` d C�CIC k�� (��S Cc��'1 <br /> CONTRACTOR NAME: � (,i�,:i ,'� � �. <br /> CONTRACTOR ADDRESS: sTReeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: " - � - <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(RE UIRED): lQ� <br /> PRIMARY CONTACT: '�OWNER ❑CONTRACTOR ❑OTHER(Please Specify) '� <br /> CONTACT NAME: CONTACT PHONE: ��S'.—�Ct���� 'Zy � � <br /> �Z%�l �c��� CONTACT EMAIL: � �r <br /> (7���L�1 Cl�i ��'�1�'r`„f� C c'�'v�' <br /> AGREEMENT:1 hereby certify that I have read and examined this application and know ihe same to be true and conect. All provisions of laws and ordinances goveming this type <br /> 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 /> local law regulating construction or the performance of constructron. That 1 am authorized by the owner of this property to pertorm 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 /> PERMIT# <br /> ��,�, ' �-- �-� E �� z - �zl--� <br /> 7 <br /> O er/ uthorized Agent ' n Date (Revised 9/23/2016) <br />