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�CTRICAL PERMIT AP�CATION <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 /> ��° � r: � ��.!t��1��T'��#"����I�Q.aMA�1�CC�; '���f�,� <br /> � � <br /> PROJECT ADDRESS: ��-[ /}�� <br /> BUILDING AREA(if residentiai,new construction,remodel,or addition} SF <br /> BUIIDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: � �� � <br /> � EC�G'�`R��ll��.A:P�'`r;rCl�'T1t�1�1 rl+��'t"��i`�`i1�►Tio�1 ` <br /> � . . _.. _ .� .. . <br /> �. �., . . __. . ., ,_,_�_ , � . .. . , ,, .�. . . .. �.,.. .,... <br /> CONTRACT PRICE OF WORK:$ �}� � <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: C � Pt- (�t,/�"Z''j <br /> � CCIN'`t'AC'F`�Fi�R��►T�#fN <br /> _ _. , ,_, . _ r. ,.. _ t. , �.. . �. . <br /> OWNER NAME: TENANT NAME(if Commerciai): � � <br /> OWNER MAILING ADDRESS: sraeer Z Oy �V <br /> cm =Y�fC.� STATE W� ziP � Z(�(.� <br /> OWNER PHONE: - OWNER EMAIL: � � (�{-� �Q� <br /> . <br /> GONTRACTOR NAME: W Z—�5 T �L�GI''-�LC.+�i�C�- ��CL-V i C.�' (,,.,_(,�� <br /> CONTRACTOR ADDRESS: SIREET M(�,�-(.(� ^�W,q <br /> ciTr L NyJ W STATE vv�A ziP CI S O � <br /> CONTRACTOR PHONE: � 2 Z - � q CONTRACTOR EMAIL: A N i t C, 'Lt U R-1 C�S� C�'"'� <br /> CONTRACTOR LIC.#(REQUIRED): �rS��.��j� Q C17Y OF EVERETT BUSINESS LIC.#(REQUIRED): cS-�{ <br /> PRIMARY CONTACT: ❑OWNER �GONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: _ .-�'-3 3 J <br /> A.�j�,� �� CONTACTEMAIL: � WG�����5•�,,..� <br /> A6REEMENT.�l hereby certify that f have read and examined this application and know the same to be true and correct All provisions of laws and ordinances goveming this type <br /> of work will be comp/eted whether spec�ed herein or nof. The granting of a permit does not presume to give authorifylo vio/ate or cance/the provisions of any other state or <br /> local law regu/ating conshuction or the pertormance of construction. That i am authorized by the owner of this property to perfomt the woNc for which application is made and! <br /> comply wifh the State Contracfors Law 1827 RCW and 296200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Z �� �7 E �� 02 � �� <br /> Own /Authorized Agen S' n u te � (Revised 9/23/2016) <br />