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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 /> PROJECT ADDRESS: �� 'S� � �� vV Lt O1�ZQ� <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 /> CONTRACT PRICE OF WORK: $ � <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: �7 � Z(� Ot 1'}'1 �/e(MCOI�UI l�r/1/L� �, (�� �CJ �� V'���� � <br /> Pixf,f,c�cs � , o�-�r�r- � 2 l c� f <br /> CONTACT INFORMATION <br /> OWNER NAME: Q! ��/(�'Q/f�j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREET CQ I cS� U � V' <br /> CITV �� STATL' "� ZIP ��� <br /> OWNER PHONE: �'/Z�� �—��p5� OWNER EMAIL: <br /> CONTRACTOR NAME: �-�'(/f � G 1 �/ <br /> CONTRACTOR ADDRESS: sTaEET �G,J� �`�`fI/( ��U� <br /> CITY �i�'P CJ��l�"'✓ � •' � STl�TE LIP OZ�� <br /> CONTRACTOR PHONE: �2 5 DCP� CONTRACTOR EMAIL: @/ �LYC���• �"l2J <br /> CONTRACTOR LIC.#(REQUIRED): l N�/ v�/(��-l �Z G CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �!"!l ID 27 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ER(Please Specify) <br /> CONTACT NAME: l� `" ` CONTACT PHONE: C �2�' 7 CP� ^ 2C73 <br /> CONTACT EMAIL: /� ��,f �� ��� �. (�--r� <br /> AGREEMENT.1 hereby certify that I have read and examined this application and know the same to be tru nd cor�ect. All provisions of s and ordinances governing this type <br /> of work will be completed whethe�specified herein or noL The yranting of a permit does not presume to give aufhority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I <br /> cornply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � 2 <br /> r <br /> __ �/�s �� E �� t�S J <br /> Ownerl t oriz ign ture Date (Revised 9/23/2016) <br />