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ELECTRICAL PERMIT APPLIGATION <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 /> PROJEGT ADDRESS ��S L�� Tl Ul'i I� <br /> �E ��'E-� � �. � ✓�_�.t�: ���3 <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 /> us�o�sustotir�c: <br /> �,,,�TRt L APPLIGATION INFORMATION <br /> CONTRACT PRICE OF WO : $ (��J <br /> NUMBER OF DEVICES if lo <br /> FIRE ALARM? ❑YES �NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRiPTidN OF WORK: A�V�x; c��=i 4 r Fv "f����iut 5 S �._-�-r�� �-f��'r£� <br /> CONTACT INFORMATION <br /> OWNER NAME: ��l...s �,�,C��(, TENANT NAME(If Commerciai): <br /> OWNER MAILING ADDRESS: srReer <br /> crrv STATE ziP <br /> OWNER PHONE: `'I ZS- �lG l Q��S 1�i pWNER EMAIL: �� ►-1��� � �t��lUCT �.�.'''� <br /> CONTRACTORNAME: Ptr-'�E-�L'a'�- [-' t.i:c_�z,3_�_ <br /> CONTRACTOR ADDRESS: srReer � Z ��,�� �L1'T.-�.T:E F_ �� <br /> ciTv ��^tl..l_�,�,G;c�J sTA� �,�7 ziP `I�L..3S <br /> CONTRACTOR PHONE:I��Eei 3(S! — G l'L'L. CONTRACTOR EMAIL:I�'��-�1n�'�E.it��--C`'- G�n'�A-c� c,��-.- <br /> CONTRACTOR LIC.#(RE(]UIRED):�/A+JUE�f� '�j5�- CITY OF EVERETT BUSINESS LIC.#(REC ;�� i�'V��� <br /> PRIMARY CONTACT: �-pWNER �-CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: —�-;��EL V q'.,,�,2p��. CONTACT PHONE: � ��� . (�1"L <br /> CONTACT EMAIL: <br /> AGREEMENT:1 hereby certify thai 1 have read and examined ihis app/ication and know the same to 6e true and correct. All provisions of laws and ordinances goveming this lype <br /> of work will be compieted whether specified herein or not. The granting of a permit does not presume to give authority fo vio/afe or cancel fhe p�ovisions of any other state or <br /> local law regulatinq constructfon or the performance of construction. That I am authorized by the owner of this property to peiform the work for which application is made and I <br /> comply with the State Contractors Law 1B.27 RCW and 296.200 WAC. <br /> �_J City of Evereft Official Use Only <br /> PERMIT# <br /> �/�/�� E �'� b�' ��-I <br /> OwnerlAuth ed Agent Signature Date (Revised 9/23/2016) <br />