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EL�TRICi4L. PEF�MIT /�P��ATION <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��� �.:�:�g � <br /> PROJECT ADDRESS: e,^ <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-A-f�'ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: � C,OMMERGIAL <br /> USE OF BUILDING: <br /> ' LECTR � AL APPLICATION,INFORMATION ` <br /> CONTRACT PRICE OF WORK: Z a�(y � <br /> NUMBER OF DEVICES (if low vo tage): <br /> FIRE ALARM? ❑ YES O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �; `y� r- <br /> � � ._. ._ <br /> , <br /> CONTACT IN,FORMATION - <br /> OWNER NAME: '' �)iYL� � TENANT NAME(If Co�nmercial): ��j�h.� <br /> OWNER MAILING ADDRESS: sTRee-r lOI� � ^ (1� ` <br /> CIIY � STATE ZIP /p G�0� <br /> OWNER PHONE: OWNER EMAIL: <br /> .....�, .... ...,..,__......_,_..................... ....,......._......,........._........ . .._... ..._ ...........�:_. ..... .:.,_...__._. :. ...._�..._.... ...... ._.... . �.._.._........:.......... ......._ _. .. ........_.�._,..._... . . ._...._..... <br /> CONTRACTOR NAME: y c/ � �� � 1�011� <br /> CONTRACTOR ADDRESS: sTReer i/, �r^,� <br /> cirv STATE i/►� ziP / <br /> CONTRACTOR PHONE: �Z - � .Gy CONTRACTOR EMAIL: sGp � <br /> CONTRACTOR LIC.#(REQUIRED): (, q0 CITYDF EVERETT BUSINESS LIC.#(REQUIRED:(JZ� <br /> ._.._.....,.,.�....�...._..,....,.�.,..,_.,..._.......r..�,.._.........._.._..,.. ._ ._. ..�.,.......�...,............. ....�._._,..�.....�._...v.,......,.,_.�...............,.�.n._:._,....._.w_...._�,..�_,.�.._..........._._........__.......,..,...,.., <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: l.�'f�'- g 3(�. (o� <br /> �I/1 �O r � CONTACT EMA(L: " � <br /> AGREEMENT.•T hereby certify that!have read and examined fhis application and know the same to Be true and correct. All provisions of laws and ordinances goveming fhis <br /> fype of work will be crompleted whether specified herein or not. The granting of a permit does not presume to give authori(y to violate or cancel the provisions of any other state or <br /> /ocal law regulating consfrucfion or the perFormance of construcfion. That I am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Offrcial Use Only <br /> FEE <br /> �O �_ <br /> PERI1�dT# <br /> I zy E ��� �- �g � <br /> r � <br /> Owned uth ized Agent Signature Date (Revised 10/92/2095) <br />