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�` �LECTRICAL PERMIT A��LICATION
<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
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<br /> _ PROJECT SiTE INFORMATION'`
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<br /> PROJECT ADDRESS: �'T' $� � ` g�� �
<br /> Bi11LDING AREA(if residential,new construction,remodel,or addition) SF '
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-A7TACHED ❑DUPLEX �MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: (f(„ .� � L
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<br /> . _ .. ; , ELECTRICAL APPLICATION 1NFORMATION �
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<br /> CONTRACT PRICE OF WORK:$ .
<br /> NUMBER OF DEVICES(if low voltage :�
<br /> F1RE ALARM? ❑YES ❑NO -
<br /> ASSOCIATED BUILDING PERMlT#(if applicable):
<br /> DESCRIPTION.OF WORK: C� b�1 ,��7� �,� J� -t.
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<br /> CONTACT INFORiV1AT10N . °
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<br /> OWNER NAME: �N�y�G ' TENANT NAME(If Commercial): (
<br /> OWNER MAILING�ADDRESS: srREEr� -�l Z''� S
<br /> ' CITY STATE'�� ZJP
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTORNAME: ��r[� "'r(1.J VLG�S
<br /> CONTRACTOR ADDRESS: Z �� � �V� �
<br /> . . .s C�f"C�N/�,t�V��y ��S � STATE �/V ^
<br /> ZIP
<br /> CONTRACTOR PHONE: Ck�.��Z,�C�.�-SZ CONTRACTOR EMAIL: --! L-t-� .4�ZS� e,�� � �,,.�
<br /> CONTRACTOR LIC.#(REC2UIRED): ��c � c�d �l/�,3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)• ,�'
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<br /> ONTRACTOR ❑OTHER(Plea,,:.�,,..,�.�,n.�_,....�....�...�...,..,o.-_��....�.�.....,�;..w,,.�,......-.... ....:.�., �.,..�.,..
<br /> PRIMARY CONTACT: ❑OWNER se Specify)
<br /> CONTACT NAME: CONTACT PHONE: �Z��,,,k SZ,Z�
<br /> J C��L N��C t„� CONTACT EMAIL• �t�,�J (v3ZS � �ST�) � Go,��
<br /> AGREEMENT.�T hereby cerfity that I have read and examined this application and know the same to be true and correct. AJ!provisions of/aws and ordinances goveming this
<br /> type of work wil!be complefed whefher spec�ed herein or not. The granGng of a permit does not presume to give authority to viotate or cancel the provisions of any other state or
<br /> local law regula6ng consfruction or the performance of construction. That l am aufhorized by the owner of this prope�ty to perform the work for which application is made and 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> Cify of Everett Official Use Only
<br /> � FEE
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<br /> PER IT#
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<br /> Owner/Author' dA entSignature Date (Revisedl0/12/2095)
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