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i <br /> ELECTRICAL PERMIT APPLICATION <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 /> ` , : �ROJ�CT �17E iJ�1FOR�lIA�a{jN ' <br /> � - <br /> z; - �; v dm. ...�t 4 „a. ...�,h,.��S�vm„?� k�3,: . <br /> PROJECT ADDRESS: O� ,w� �� � ��: �� ���7�I,��, ll�a`'� .G�1 <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: O SFR-DETACHED O SFR-ATTACHED O DUPLEX O MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: � J A <br /> -;" ELECTRI,CAL APPLt�A�'lO1V INF�RIVIAT101�.; . `. .�, .. :.,. . . �.' . <br /> .....,..�. ,. ._ .. . . ., ,.H. . .,.. . . _.... ,. <br /> CONTRACT PRICE OF WORK: $ � S C7O� <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? o YES NO <br /> ASSOCIATED BUILDING PERMIT# if a licabie : <br /> DESCRIPTION OF WORK: �r{�,� k�` LJ��C� �' Gt;�M�I'f.� ��' o� <br /> CONTACT INFORMATION <br /> OWNER NAME: e„�r• �m fi�� TENANT NAME(If Commercial : <br /> OWNER MAILING ADDRESS: srReer <br /> cirr " sTn� ziP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1�� p I,) ; �' C.,• <br /> CONTRACTOR ADDRESS: STREET 2.� 1'1aC i/1�'•. i�Z.. <br /> cirv '�C��'�.�}'f' STA'fE �JJ� ziP (�2�I <br /> CONTRACTOR PHONE: j-I'�.S`�)3��'(��� CONTRACTOR EMAIL: CQ}1'tfr�C.'�" i(it,J. C.C�� <br /> CONTRACTOR LIC.#(REQUIRED): (�, �� �� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(7�j3 '�I <br /> PRIMARY CONTACT: o OWNER CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �(�-�)'?-I,.f�jD� <br /> ,� ����C�' CONTACTEMAIL: Q,,�{'�;1��(,�;(��, (�j;� <br /> AGREEMENT.�I he�eby certify that/have read and examined this applicaSon and knowthe same to be t�ue and correct. Al/proVisions of/aws and oidinances goveming this type <br /> of work wi/I be comp/eted whether specified her2in or not. The granting of a permit does not presume to give authorify to vio/ate or cance/the provisions of any other state oc <br /> loca!la w regu/a6ng construction or the performance of construction. That/am authonzed by the owner of this property to perform the work for which applicaSon is made and I <br /> comply with the State Confractors Law 18.27 RCW and 296.200 WAC. <br /> . City of EvereB ON'icia/Use Only <br /> PERMIT# <br /> . / (� 2�� 1 � Ee�v �—�q � <br /> Owner/Authorized Agent Signature Date (Revised 923/2016) <br />