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. <br /> �LECT ICAL P iVlll' AP L! T'I�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320� CEDAR STREET, EVERETT, WA 98201 <br /> (P}425-257-881t1 � FAX 425-257-8857 � (E)everetteps a�everettwa.gov � www.everettwa.gav/permiks <br /> PR03EGT SITE INF+DRMATION <br /> PROJECT AQDRESS: �a�,,� /y��-t1 �=U� Q( <br /> BUI�DING 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 /> ELECT°FtICAL APPLICATION INFORMA`TI�R! ' <br /> CONTRACT PRICE OF WORK: $ � uU <br /> NUMBER�F DEVICES (if low volta e : <br /> FIRE ALAF2M? ❑YES NQ <br /> ASSOCIATED BUILDING PERMIT# if a licable): U�. <br /> DESCRIPTfON �F WORK; U�� t�O�P l/ P1" t' .0 ,5 r°tJ �GJ� d ' <br /> i <br /> c{r ' � C <br /> } <br /> CONTACT INFQRMATIbN <br /> OWNER NAME: f�p� �(/ TENANT NAME(If Commercial); � <br /> OWNER MAILING ADDRESS: srReer c2(�J� CFA.t'r5 S C � OO <br /> CITY C�f STATE ZIP /O<Y�� � <br /> t <br /> OWNER PHONE: a5�a�9- a� Y OWNER EMAIL: '• � �° tL. � j <br /> � � <br /> CONTRACTOR NAME: Q ' (?G�"i� � <br /> CONTRACTOR ADDRESS: srReEr ,3S�I �u�cZr� � � <br /> ��7y � STATE ZIP � �7 <br /> CONTRACTOR PHONE: c�J- 7- d` CONTRACTOR EMAIL• � r� ' <br /> GONTRACTOR LIC.#{RECtUIRED): Q G G ` � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): P��c�(I <br /> PRIMARY CONTACT: ❑OWNER CZf CONTRACTOR ❑ OTHER(Please SpeciEy) <br /> CON7ACT NAME: CONTACT PHONE: a4 „ 7 r('�� <br /> � �F CONTACT EMAIL: � r � �e t�i <br /> AGREEMENT:I 6eieby ce�tily that!have read and examined tlfis applicatipn and know the same to be true and correct. Ad provrsions af taws and ordrn nces governing this type <br /> of work wiM be eomp/eted whether specified herein or not. The granting of a permrt does not presume fo give authority to violate or canceJ the provisions of any other stafe or <br /> loca!!aw regulating construcfion or tl�e performance of construction, That 1 am aulhorized 6y iha owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 29&.200 WAC. , <br /> Cify of Everett Offrcia!Use Onty ', <br /> PERMIT# <br /> .�.w. _ _ =� a _ � ao�7 E �� <br /> OwnerlAut ized Agent Signature Date (Revised 9/23/2016) <br />