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ELECTRICAL PERIWIIT�'bPLICATION <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 /> PROJECT ADDRESS: �d tz,�t�Cv '�u l�..pt N� 4�J-Z� �('j(� t.c� �oq5 i 1.;(j (— E^�' �j <br /> BUILDING AREA(if residential, new construction, remodel,or additionj SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: `j(y �. ��1 ��y�� ��;•T�? '� �, "' �'A i=1L <br /> _ <br /> ' 'ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /�s'�^j� - <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES �NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: t t'�ti3 i�, ��J� !�{;,�,"� �, ep '►�.�i�,C\0 ?.��.v� <br /> c���� ��.��zr� �b <br /> : CONTACT INFORMATiON _ <br /> OWNER NAME: ���� � TENANT NAME(If Commercial).: � �� Vr� �'/f,��{C1�'S �s}F� <br /> OWNER MAIUNG ADDRESS: srReeT `aU�L��i1J �(��2Z 3 v63 i� C�S��C7 R� <br /> arr �l,�'� 1� ,1 STATE wd4 Z�P C7 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTORNAME: j�y�, �(,'�(Gtj� �L.j�,�2'Ye <br /> CONTRACTORADDRESS: sTReeT 2.3�L/� 36T�I��p"' S 1 �9' <br /> CIIY ��7/�� � STATE �� ZIP � g�} <br /> CONTRACTOR PHONE: �d�• "��-2.�'g(o(� CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 'QtJ't'1r� \' �` CITY OF EVERETT BUSINESS LIC.#(REQUIRED): � �(a•2, <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ��� �t�NN�� 2�� �1ZU �� � <br /> CONTACT EMAIL: p�,�-�- (� ���y,� � �� <br /> AGREEMENT.I hereby certify that I have read and examined this applrcation and know the same to be true and correct. AlI provisions of laws and ordinances governing this type <br /> of work will be complefed whether specified irerein 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 /> /ocal law regulating construction or the performance of construction. That I am authorized by the owner of this property to_perform the work for which application is made and I <br /> comply with the State Cont�actors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � � /� E l b2✓�12 <br /> Own /Authorized ent Signature ate (Revised 23/2016) <br /> ( <br />