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_EGTRICAL PERMIT A LICAT'ION
<br /> CITY OF EVERETT PERMlT SE VICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P) 425-257-8810 � FAX 425-257-8857 j (E) everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> .; , ,._ _ ._ . ... , �.a� _, . ..�
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<br /> ; ,' . _ ; PROJECT SITE INFORMA710N <
<br /> Pi20JECT ADDRESS: gQ (�(�;
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) R�V,���� SF ��
<br /> BUILD[NG TYPE: ❑SFR-DETACHED ❑SFR ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> USE OF BUILDING;
<br /> ' ELECTRICAL APPLICATION INFORM.ATION
<br /> . .... .. . _ ,.. _ ...._. _....._ _�.
<br /> . _ : . .,. . . ._..: .. .: . .. .. . .. . .......
<br /> CONTRACT PRICE OF WORK:$ �jQb�,DC:3
<br /> NUMBER OF DEVICES (if low voltage): �(�
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicabie): �� � d
<br /> DESCRIPTION OF WORK: /�} ', �� �. {� �.i�' �c���Y1 q-� yy�
<br /> -�A�S �- w rc.u��- f� L;
<br /> CONTACT INFORIVIATION �
<br /> OWNER NAME: '�+ �11 a� r i e TENANT NAME(If Commercial);
<br /> OWNER MAILING ADDRESS: srRee-r ''� W
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<br /> crrr I_ Sv srn� z�P
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: lS(:Cv��U�Nl � �'`f, Ll-�
<br /> CONTRACTOf2 ADDRESS: � STREET )f ��'
<br /> ��n La �+evc�, � STA� ra�- Z�P 9�a��'s
<br /> CONTRACTOR PHONE; ��J"� Q--O�O� CONTRACTOR EMAIL: JCIVI� �� ��: 4LC C7 V�/1(��I . �pY✓�
<br /> CONTRACTOR L1C.#(REQUIRED): � � �j'� CITY OF EVERETT BUSINESS LIC.#(RE(lUiRED): ` '��j�
<br /> �, ,�wx,...:..�...�._.�._�.,.�,.T.,�..,..a.a,� .,�..�,_._..,.,,�...�r. ..�.�.,�.,,�...�.� _._..,,.....�.,.__r�..�....,..,,..�-� ..v.�...... ry.�...w,d.,,�._�.w.�..M,,. �w..r....,.�_...�,..w„w ,,.�..�....M�...vv.�_,.. .,..v,. ��._..,_,...�..,.2....,
<br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: t��LJ- ��(�_� o�{
<br /> ���S ���0'���Sc'�Y� CONTACT EMAIL:
<br /> AGREEMENT.•T hereby cerfify that I have read and examined this application and know the same to be frue and correct. Al1 provisions of laws and ordinances goveming this
<br /> type of work will be completed whether specifed herein or not. The granting of a permif does not presume fo give authorify fo violate or cancel the provisions of any ofher state or
<br /> /oca/!aw regulating construction orthe performance of construction. That!am authorized by the owner of this property to perform the work for which application is made and l
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 W,4C.
<br /> Cify of Everett Offrcial Use Only
<br /> FEE
<br /> �
<br /> � 8��
<br /> PERMIT#
<br /> �_L�- 1� E C(��Z� d2�
<br /> Owne th d Agenf Signature Date (Revised 90/12/2095)
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