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ECTRICAL PERMIT AP�ICATION <br /> CITY O� 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.govlpermits <br /> PROJECT SITE INFORMATION ` <br /> PROJECT AQ[1RES5:3�+��J -� w� � � <br /> BUII.DING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED �pUPLEX �MULTI-FAMILY-#OF UNITS: L�GOMMERCIAL <br /> USE OF BUILDING: .��cj"(l�VL�-�{'1�C'"r <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$�p� <br /> NUMBER OF DEVICES if low voita e : <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDfNG PERMIT# if a licable : <br /> DESCRIPTIONOFWORK: 4h1�3(�rW � `) �+~'I�i��X ���� JFi�11'�,� � bil�fvE, ��( 'S��'i' <br /> 1��?( . �. '� �iT Fs ' C�ll'C <br /> CONTACT INFORMATIQN <br /> OWNER NAME: /�1�!IV� ���(�[�5 �i�Ci TENANT NAME If Commercial : �1��G\��`��� ��J1� '� (7��i <br /> OWNER MAILING ADDRESS: srReEr�� �j $ �, <br /> ciTv . � -'(� STATE i+�f� z�P�'{�i�n I <br /> OWNER PHONE: �O�P'� %-ij f``` QWNER EMAIL:�.el, �-E'i j{�I a1 /�, � <br /> CONTRACTOR NAME: M�Xl 6'f�1 li�� c�,(D/( $-F�G°f-�LI1�1� S)� �-�11/�1'� �NN�i <br /> CONTRACTOR ADQRESS: STREET �b��1(�� N�i/l�L�i�i�� V�!'!�I'�i <br /> CITY ��qa+ � STATE •y� ZIP � �J' <br /> CONTRACTOR PHONE: �IQ�}�LI'�"�' � (Z� CONTRACTOR EMAIL:YY11�IG C'SI/10 V"' � Y • � <br /> CONTRACTOR LIC.#(f2EQUIRED}:$ 0�5}k'�I$�l`�I CITY OF EVERETT BUSINESS LIC.#(REQUIREP: ''-{'��� <br /> PRIMARY GONTAGT: ❑pWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ���,.r' '� � -��f <br /> ��� ��%'����'� CONTACTEMAIL: y�/i�� h �����i�/i $`f ' t. <br /> AGREEMENT:l hereby certify that I have read and examined this application and know the same to be true and correct. A!1 provisions of laws and ordinances goveming this type <br /> of work will be completed whether speciffed herein or rrot. The granting of a permit does not presume to glve authority to vlo/ate or cance!the provislons of any other state or <br /> locat law regulating construction or the performance of construCtion. That!am authorized by the owner of this properfy to perform the work for which application is made and! <br /> comply with the State Contractors Law f 8.27 RCW and 296.200 WAC. <br /> City of Everett O�cia!Use Only <br /> PERMlT# <br /> � � E ��2 - ��`� <br /> Owner/A thorized Agent Signature Date (Revised 9/23/2016) <br />