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_ECTRICAL PERMIT �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
<br /> $ PROJECT SITE INFORMATION' £ � '�°
<br /> � �__. � � _�,� �.
<br /> PROJECT ADDRESS: z5 Z3 ���Z rt�� AS� - J�v���Z ���{ �'���
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) f��'�O� SF `�i Z�DD � -� _
<br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDWG: �C�i
<br /> ELECTRICAL APPLICATION.INFORMATION,
<br /> CONTRACT PRICE OF WORK: $ � 5'S� • ��
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): i3 I 5 ( Z'- 0 I�-}
<br /> DESCRIPTION OF WORK: ��C� �'M'� }�L� ��D '�f�l�
<br /> � . , . : .,
<br /> ,,. : v .., �
<br /> ' ,.. ' , ` CONTACT INFORMATION "
<br /> OWNER NAME: ��-`Yl`�L�) � G Iww� �m• (.(_C TENANT NAME(If Commercial): (� �
<br /> OWNER MAILING ADDRESS: srReer � QO�c �I '�'J 7
<br /> CITY StiD�J��1� STATE W� ZIP ���/`�'S
<br /> OWNER PHONE: �"fZS —�S�� 2`j�I OWNER EMAIL:
<br /> ,.., ..��. . .... ...._ . __..., ..._. ........ .. ... ,_. �... ...... . ....�.. . . ....�_ , ,._. ....,. .. . .
<br /> CONTRACTOR NAME: �I�'� �`Cc`h—� C
<br /> CONTRACTOR ADDRESS: sTRee-r �O"U O Z ��Zc'�� �3�` �D , � 3�" f J SS
<br /> CIIY -�'C /\ � � L� STATE �/1TT� ZIP �U 3�
<br /> CONTRACTORPHONE: �I� �j0°f ��f�D CONTRACTOREMAIL: �1J�7'12�eL�rC � a�A�� COWL
<br /> CONTRACTOR LIC.#(REQUIRED): �I� �9 I p�G—' CITY OF EVERETT BUSINESS LIC.#{REQUIRED):b�}���
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2ob �{7�``d�J�j
<br /> ��.J�� ��"[��/� CONTACT EMAIL: ol�tvlGl�G`�G °� C��c�G .Gc,yy�
<br /> AGREEMENT.•T hereby certify that I have read and examined fhis application and know the same to be true and correct. Ali provisions of laws and ordinances goveming this
<br /> type of work wifl be completed whether specified herein or not The granfing of a permit does not presume to give authority to violate or cancel fhe provisions of any other state or
<br /> local law regulating consfruction or the performance of construction. That l am aufhorized by the owner of this property to peiforrn the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 W,4C.
<br /> Cify of Everett Official Use Only
<br /> FEE
<br /> Za�{- z�
<br /> PERMIT#
<br /> C z�`��,� E 1(0 ��- o�`
<br /> 0
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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