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ELECTRICAL PERMIT �►PPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everetfinra.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS: j� . �19-,stJ1/Q �Br4,� -- l��r'1 � <br /> BUILDING AREA(if residential, new construction, remodel,or addition) ��d SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX �'IVIULTI-FAMILY-#OF UNITS: /Zi' ❑COMMERCIAL <br /> USE OF BUILDING: /�s/,��/?'"f U2��jQYr!/l y <br /> ELECTRICAL APPLICATION INF.ORMATION ` <br /> CONTRACT PRICE OF WORK:$ �° v="� <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES f�0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .� <br /> DESCRIPTION OF WORK: / p Ot-[� F4�. G�1 � C�>4/,� <br /> � �.��- <br /> CONTACT INFORMATION <br /> OWNER NAME: �l Cl/'4 ��1���� TENANT NAME(If Commercial): 11�. <br /> OWNER MAILING ADDRESS: sTReeT O G'�� ��ND - A A <br /> CITY ��/��'` STATE V V r' ZIP PO�� <br /> OWNER PHONE: yZ� �I�=970,� OWNER EMAIL: N ✓4" <br /> CONTRACTOR NAME: �7�Y��ZC �C��� <br /> CONTRACTOR ADDRESS: srReer �7 Z 6 C� ' �y <br /> CIN ,��/�// STATE � ZIP V �v/ <br /> CONTRACTOR PHONE: Z�,ZFu�'- 76CJ� �, CONTRACTOR EMAIL: G���L�/YuT�� P � �c�►n�' Gt7�I <br /> CONTRACTOR LIC.#(REG2UIRED): '{�l�'rC.�Q7J,�C CITY OF EVERETT BUSWESS LIC.#(REQUIRED): � ��0'� <br /> _ _ _ _ _ __ _ <br /> _ _ <br /> PRIMARY CONTACT: �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L�ZS- ��g'� 76�,j <br /> ��t�J' /��/Yr/� CONTACT EMAIL: � i j2�NL1�T`�J 6 �'J�{V`�'CCll1� <br /> AGREEMENT.•1 hereby certify that I have read and examined this application and know the same to be true and correck 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 cance/the provisions of any other state o� <br /> focal law regulating construction or fhe 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 Confractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> . _ � � E �� g - O� <br /> O er/ orized Agent ignature Dat (Revised 9/23/2096) <br />