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���� - t� 5 <br /> ELECTRICAL PERMIT APPLICATION <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 /> PROJECTADDRESS: � fl �Z. �/� � /J�Zia..�� � � � <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF ��►'t D��L- <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATfACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: R�J/� {l— <br /> ELECTRICAL APPLICATION INFORMATION` : <br /> CONTRACT PRICE OF WORK: $ v � <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES �O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �(/�z /l�G. � F��-�� C /}-N�.- mit'j!'* <br /> f' '—Cl �i/ @ � t� ��'�s�-`T� t t-� ' <br /> CONTACT:INFORMATION _ <br /> OWNER NAME:� /V� ��" TENANT NAME(If Commerciai): - <br /> OWNER MAILING ADDRESS: srReer (� S��z .L�2j�fl '�-^ <br /> 1 <br /> CITY STATE ZIP 7 Q <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �(%��r'- /� ej� <br /> CONTRACTORADDRESS: sTReeT �{ `� 21I �LIS'! �l�� !9/?� `�1 � � <br /> CITY �/� STATE /T` ZIP ��G� <br /> CONTRACTOR PHONE: �2��- 6�J� � � CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):� � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: �WNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ��'r � r �(,�' <br /> �\�/��Q'/� Cs�'`l�Gf�!L CONTACT EMAIL: �'�'��,�.e � ,c f�'J�/� • �D� <br /> AGREEMENT.�I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the pertormance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ��� <br /> �7 E ��� -- � g Z <br /> O e uthorized Agent Signature Date (Revised 9/23/2016) <br />