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ELECTRICAL. PERIVIIT �LICATION
<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
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<br /> ' ` ' PROJECT SITE INFORMATION:> �
<br /> . ... . _ $ _.<_. . , , . . ..,,.
<br /> PROJECT ADDRESS: / ��� � Y"t�� (,�� �►/i y� vv 1 ��✓��
<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:
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<br /> ? ': '� ELECTRICAL APPLICATION INFORMATION� ;'; ' , ':
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<br /> CONTRACT PRICE OF WORK:$ ����� —� •
<br /> NUMBER OF DEVICES(if low voitage):• �
<br /> F1RE ALARM? ❑YES ,I�NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): J�
<br /> DESCRIPTION OF WORK: � .,.� i V' �L�Zs Z-�
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<br /> CONTACT INFORMATION _
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<br /> OWNER NAME: /4 �/' �,^� TENANT NAME(!fi Commerciaf): ;��, C`�
<br /> OWNER MAfLiNG ADDRESS: srReer �� p �- �
<br /> CITY "' ✓�Y2 STATE VY ZIP ���4 /
<br /> OWNER PHONE: � ���� �..m�"�',,,,,.. � �1 OWNER EMAIL:
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<br /> CONTRACTOR NAME: ��l Y` �,.. lr�l-2�" �u-� � %' a/Gz
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<br /> CONTRACTOR ADDRESS: srReer �r � .�„�t/1 �" '�'�( (�"
<br /> CIT1' �t . C � STATE � ZIP ..�,4�� �
<br /> CONTRACTOR PHONE: �i�(j? '�J I �j,l'��� CONTRACTOR EMAIL: '�� � " Q �' ' _ �L� !�/(,
<br /> CONTRACTQR LIC.#(REG2UIRED): � � � 1,, CITY OF EVERETT BUSINESS LIC.#(REQUIRED):U.S �l, �
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<br /> PRIMARY CONTACT: ❑OWNER l�'CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT yA�V1E: CONTACT PHONE: ._ � � ' � � �
<br /> � � 1 � Q � �- CONTACT EMAIL: uJ� - .� ,�
<br /> A6REEMENT.•T he�eby certify that I have re and examined this application and know the same to be tn�e and correct AU provisions of laws and ordinances goveming this
<br /> type of work will be completed whether spec�ed herein or not. Tire granting of a permif does not presume to give authorify to violafe or cance!the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That!am aufhorized by the owner of this property to pertorm the work for which application is made and l
<br /> comply with the State Confractors Law 98.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
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<br /> � � � PERMIT#
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<br /> OwnedAuthorized Agent Sig atu—re`� Date (Revised 90/12/2095)
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