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LECTRICAL PERMIT A�ICAT'lON <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 /> ; , . . _ .. . ; . _ _ <br /> _ , <br /> ..., <br /> ' PROJECT SITE INFORMATION ;. : <br /> �� � ,. <br /> _ . .. . ._ <br /> _ _ <br /> PROJECT ADDRESS: `�D(°j'�'' -�� � �'���C9`� �, �'� �� <br /> BUILDING AREA(if residential,new construction,remodel,or addition) �� � SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATi'ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> , ., : �> .._ , �... �. <br /> ' , ELECTRICAL APPLICATION INFORMATION ' <br /> CONTRACT PRICE OF WORK:$ �3 �j �o - "{' <br /> NUMBER OF DEVICES(if low voltage):� �� <br /> FIRE ALARM? t�l YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: L�, C�Sc ` � � c.� ' <br /> ��-e JC f.�S ; . <br /> � �x,-�� S -� • <br /> ; <br /> _ _. : <br /> , _. <br /> CONTACT INFORMATION. . <br /> OWNER NAME: i�/l�t., $c�-�� � . TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReEr �Qp W�2 - �� ' �-I,'�—+U� t'S{ '�, <br /> �� t-�,-�. �-� STATE �P 9 �ao�� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � ;�.�- ��'1 <br /> CONTRACTOR ADDRESS: sTReer Q, <br /> ciTv STATE ziP <br /> CONTRACTOR PHONE: �'�3"��' �jR-- Q CONTRACTOR EMAIL: 4— �,�- � Y•-, <br /> CONTRACTOR LIC.#(REQUIRED): �` j a�l CITY OF EVERE7T BUSINESS LIC.#(REQUIRED):) ��L�w <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �'1,�`j � �--�,.��{ -- � � '�Q � <br /> �0��-� t � CONTACT EMAIL: r., � <br /> AGREEMENT.•T he�eby certify that I have read and examined fhis application and know the same to be true and cor . All provisions oflaws and ordinances goveming this <br /> type of work will be completed whefher specified he�ein or not. The granting of a permif does not presume to give authority fo violate or cancel the provisions of any otherstate or <br /> local law regulating construction or the performance of construction. That l am authorized by the owner of this property fo perform the work for which application is made and I <br /> comply with the Sfate Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Evereit Official Use Onty <br /> FEE <br /> � � �2 ��.� <br /> PERMIT# <br /> � � �� E C�08��`fl <br /> Owner/ uthorized Agent Signature Date (Revised 10/92/2095) <br /> . `� <br /> � <br />