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_ECTRICAL PERMIT A�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-2�7-8857 � (E)everetteps a�evereitwa.gov � www.everetiwa.gov/permits <br /> �� � PROJECT SITE INF�ORMATION; � <br /> , <br /> - ��-� ,. � _��.. � .�� <: �.� , , _t�F_� _ .-.,, � <br /> _ . ._ _ _ _ �.� _, _ _,z�� .w__� f�._ « <br /> ,_ _ ,_ .__a �,�_� <br /> PROJECT ADDRESS: O �� �t'7` �"�.G�^e� �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 OP BUILDING: ���,/^ �j�r,�',��j � <br /> LECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ f f� i�J4f, <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable : <br /> DESCRIP.TION OF WORK: � <br /> , .. , ,,_ .., , . �r- r � <br /> CONTACT INFORIVIATION, ` <br /> - , ..._ _ _ . _, � , _, . . . ., � _ <br /> OWNER NAME: G'� • � TENANT NAME(If Commercial): ,�.� <br /> OWNER MAILING ADDRESS: sTaee-r � <br /> CITY - 2 STATE j� ZIP ��"f� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �,.- <br /> CONTRACTOR ADDRESS: s-rReer <br /> � CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> LIC.#(REQUIRED): �'II�/Ld L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � �'�i, <br /> �l�/o«/�}'u-�` GONTACT EMAIL: <br /> AGREEMENT.•T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this <br /> type of work wiil be completed whefher 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 ihe performance of construction. That I am authorized by the owner of this properfy to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> Cify of Evereif Official Use Only <br /> FEE <br /> � ����/ <br /> PERMIT# <br /> � �� - � E ��o�' �� � <br /> Owner/Authorized Agent Signature Date (Revised 90/12/2015) <br />