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`` � �ECTRICAL PERMIT AP <br /> _ �1CAT1�N <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 J www.everettwa.gov/permits <br /> . . <br /> , . , __. �. <br /> _... <br /> , " � PROJECT SITE INPORMATION <br /> �. , _..: - .: . <br /> , . .. <br /> PROJECT ADDRESS: �'T' s� � . � g Z� tr' <br /> b-- <br /> BUILDING AREA(if residentiai,new construction,remodel,or addition) SF ' <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX I�MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: f f�, � � '� <br /> ,,. ; .. . <br /> .:. . <br /> . .. . . <br /> . . . .. ., _,. .. <br /> ELECTRICAL APPLICATION INFORMATION � <br /> , .. .: , .. . . .... .. _ �, . ..- <br /> CONTRAC7 PRICE OF WORK:$ � . <br /> NUMBER OF DEVICES(ifi low voltage :� <br /> FIRE ALARM? ❑YES ❑NO - <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION.OF WORK: C� bcJ �sty'�7� L..1 � '�- <br /> ._ . , . <br /> .. <br /> - ` CONTACT INFORNIATION_ _ <br /> ... ... _ ;:.. ... . <br /> OWNER NAME: `���G ' TENANT NAME(!f Commercial): � <br /> OWNER MAILING ADDRESS: srREEr� -���.� s <br /> CffY STATE'Vl!� ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> .. ... . ..... .. ., . .. . . . ,., . ,. ... .. ... . . ,..... <br /> • . . . . .. .. . ... . ... . .. .. . .. _. .... ,. .. ... _. <br /> CONTRACTORNAME: �pr L "�" 1�) V�,GLS <br /> CONTRACTOR ADDRESS: Z��� � �v�' � <br /> b o��'c►^�•n��. rJ�-t S �F STA,�' W � <br /> ZIP <br /> CONTRACTOR PHONE: Ck2�-L�C�.`'SZ CONTRACTOR EMAIL: -� Lf-� .`3 Z� �+,� � ��,.� <br /> CONTRACTOR LIC.#(REQUIRED): � � c� Fl/�,�j CITY OF EVERETT BU LIC.#( .L�,� 6 <br /> SWESS REQUIRED) <br /> PRiMARY CONTACT: �p OWNERN ONTRACTOR s�OTHER.(Please Sp� fy)� � <br /> eci <br /> CONTACT NAME: CONTACT PHONE: ��Z'�(e.�SZ2L <br /> ,.J C��L NE�C(� CONTACT ENIAIL: sGN (o3Z� @ �'l�4ST�I � Ge�� <br /> AGREEMENT.�T hereby cerfify that I have read and examined this application and know the same to be frue and correct. All provisions of laws and ordinances goveming this <br /> type of work wil!be compieted whefher spec�ed herein or not. The granting of a permit does not presume to give authority to violate or cancei the provisions of any other stafe or <br /> local law regulating consfruction or the performance of construction. That l am authorized by the owner of thrs property to perform the work for which application is made and I <br /> comply wifh the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> � FEE <br /> . �� -�� <br /> �� <br /> PERMIT# <br /> �_�.�_ �_ �3 -� � E It�c2 - o� Co <br /> OwnerlAuthor' dA ntSignature Date (Revised 90/1?J2015) <br />