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<br /> �LECTRICAL PERMI
<br /> T AP�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 J www.everettwa.gov/permits
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<br /> PROJECT SITE INFORMATION':` -:'
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<br /> PROJECT ADDRESS: �,"T' s� � � ` (�ZC�
<br /> BUILDING AREA{if residenSal,new constnaction,remodel,or addition) SF �
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATfACHED ❑DUPLEX I�MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: �f�, .� (,,�,l j_
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<br /> . , ELECTRICAL APPLICATION INFORMATION ; :
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<br /> CONTRACT PRICE OF WORK:$ .
<br /> NUMBER OF DEVICES(if low voltage :•
<br /> F1RE ALARM? ❑YES ❑NO -
<br /> ASSOCIATED BUILDING PERMIT# if ap licabie):
<br /> DESCRIPTION,OF WORK:, C.� b� ,psty�7� C,� � -r.
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<br /> _ : CONTACT INFORMATION . ; . . _.
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<br /> OWNER NAME: �j��y�G ' TENANT NAME(!f Commercial)� (
<br /> OWNER MAILING ADDRESS: srREEr 4� -���.''� C�
<br /> � �m �A-� w� �P
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTO.RNAME: ��-+�[,� "'l" ►�J ^ VLC.�S
<br /> CONTRACTOR ADDRESS: � �� � �v�' �
<br /> . � �s CI��V����� �""�S � STATE �J �
<br /> ZIP
<br /> CONTRACTOR PHONE: C.�2��2,1 C.��-S Z CONTRACTOR EMAIL: -� �—t�-� .4�Z� e�� ��y�,ti
<br /> CONTRACTOR LIC.#(REQUIRED): ��c �j c� `l/l,3 C1TY OF EVERETT BUSINESS LIC.#(REQUIRED)
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<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ��Z�(�:s Z2�—
<br /> J U�C- IvC�C(,� CONTACT EMAIL: .SGN (o32�S @ �ST�I � Gl�,V��
<br /> AGREEMENT.�T hereby cerfi(y that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this
<br /> fype of work will be completed whether spec�ed herein or not. The granting of a permit does not presume to give authorify to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and I
<br /> comp/y wifh the Sfate Contrectors Law 98.27 RCVV and 296.200 WAC.
<br /> City of Everett O�cia/Use Only
<br /> • FEE
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<br /> PERMIT#
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<br /> Owner/Author' dA ntSignature Date (Revised 90/92/2095)
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