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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� www.everettwa.gov/permits <br /> �� '.�'ri�� ' �F`�l����� ;�`iM`���1��"�JiRll�l�k'T��M �j ';��..� <br /> ,� '� ., �: ,�. �,&�J���,,.a� +�'`�� , .�',..�� �...., s"�,��� ,.,:; R��,: � ,:zi, �,✓,..�+� t '., ,.,.'r <br /> PROJECT ADDRESS:� QO I�,r'� c1� �� �(�,E� G(/(;'/" � <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: Or1 OYn � C(�I� <br /> = � , ELECTR�GAL APPLIC`�TIQ1�rNFOE�M/4"��ON` � ����, <br /> � <br /> ... , , .. <br /> CONTRACT PRICE OF WORK: $ 2.,�G <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRIPTION OF WORK: �l (!� PI� � G1cI�T G'' �D��'1"1 <br /> i � <br /> �ONT�CT_(NFQRM/�►T,4,ON .., ''r' _ ,',.��� ' � � <br /> �, <br /> , `� ...; �' <br /> OWNER NAME: Q .1�G �C� TENANT NAME(If Commercial): C� (� �C <br /> OWNER MAILING ADDRESS: s-rReer ' DU' '� J�'� UYt/� �( <br /> cirr �I�f'i�Zi� srnre ziP ✓�J ZG t/ <br /> OWNER PHONE: 25 f� �6 OWNER EMAIL: r�01 A D �,T � r�h r�i1�/8le GO/Yj <br /> CONT. . e. � .... �._ �� ��. � . . �. � .. . ._....._._ __.._. .. ,� ��� <br /> RACTOR NAME: � � <br /> CONTRACTOR ADDRESS: srReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT SUSINESS LIC.#(REQUIRED): <br /> ,_ ._ , . _. ._ ., ... <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> C NTACT NAME• CONTACT PHONE: ¢2� �� �¢(J <br /> ��l/� � �6���5'G� IG�G� CONTACTEMAIL: �"(it o �� f �r"GN 0�j (G'�'A GQyj� <br /> AGREEMEN :/hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and o�dinances goveming this type <br /> of work will be completed whether 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 the performance of construction. That I am authorized by the owner of this property to pertorm the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � � �s 2�r�- E � � �- d �� <br /> OwnerlAut rized Agent Signature Da e (Revised 9/23/2016) <br />