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i <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 /> � sw.�;� �.��„��`� ��`�"� <br /> .,, .,. �_ , ..< .. . . , .� ,>._ . . ,. e_ . „ <br /> �� <br /> PROJECT ADDRESS: � Q 9 1- C� i j� �� (�(.5�� ��2� Q v <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: <br /> ` ELECTRICAL APPLICATION INFORMATION ,:; <br /> , . , . . <br /> _ _ v. . ._., . . _ ,_ _ <br /> CONTRACT PRICE OF WORK: $ ��D 6'� <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES fz�NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: CC�f G� (..S 1—!�� 2 ���� ���� S . <br /> ��-v Ct�z r'e s�s-a-- �r� � � • <br /> CONTACT:INF,ORMATION , <br /> OWNER NAME: �"e �, � ��j��QC� TENANT NAME(If Commercial): e7s Ge/�� gl��.S <br /> OWNER MAILING ADDRESS: sTReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T,���� ✓ � C �l' G <br /> CONTRACTOR ADDRESS: s-rReEr �'! 2�j �'���� S � � • <br /> CITY � S A�1 � � � STATE ZIP �� �+ <br /> CONTRACTOR PHONE �ZS �S��—S � CONTRACTOR EMAIL: �O tr' � 1,�L4�PY 236LI fMQs� ��� . <br /> CONTRACTOR LIC.#(REQUIRED): ���—rQ�^"" ! �I 1� � CITY OF EVERETT BUSINESS LIC.#(REG2UIRED):Q�j 69�.� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> �j/' V � D��C"'����5 CONTACT EMAIL: <br /> AGREEMENT.�I hereby certify that!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 othe�state or <br /> /ocal law regulating construction or the performance of construction. That l am authorized by the owner of this property to pertorm 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 /> �.,_.___._.._ �� ��-/ i 9/`�-a 2 �- E � `10 �- ��� <br /> ,..____ <br /> geh ure Date (Revised 9/23/2016) <br />