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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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �D�J ����� ,�Uf y� l��'_. <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: ���I j->c' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ( QQ``'� <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if ap licable : <br /> DESCRIPTION OF WORK: at _1�-. C' �1��_ . L�>'���' 1,�='cr.`T s�, : £',:� �-�:'�7 l:-> <br /> 1_ 1 � •l ,�`, 1 ' . <br /> �¢_ i:�:(, 0-�"'��'r`�i . <br /> CONTACT INFORMATION <br /> OWNER NAME: ��/'�.� �, (. �C. TENANT NAME(If Commercial): �I�_�c�'� �'•i;. 'd�^ pr`:' <br /> OWNER MAILING ADDRESS: sraeer I {� � <br /> 2 � 2C�G�r�?�f� <br /> cm r' ' r'.,`., <br /> .. E��F�;.'�t� ..r STATE /(� ZIP � �. I <br /> OWNER PHONE: �"�7 b ��`I�(_-1G ;�7 OWNER EMAIL: I.�Y�I e:�'t/l,�c-y,'�� ,r� ��i�''�`'��f�J .�:: �,%!, a,i <br /> CONTRACTOR NAME: �-�4%`.'. -P,,�:,<'? �,*��L <br /> CONTRACTOR ADDRESS: sTReeT ;�� � ��"f �;:�_:'t' '.��� 1;;V �- <br /> CfiY �V1['/�`L�,� STATE �/�C L. ZIP e`�' �-��� .. <br /> CONTRACTOR PHONE: � ���` � • C - (�4 C.>�� CONTRACTOR EMAIL: p�G'� �v,. c= �I�c��i��t .C�����-� <br /> CONTRACTOR LIC.#(REQUIRED):G I_.-Gt�� G� 'j�( I"�. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): � 6��` <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �� 3�Ct G f� �.�--- <br /> JG�I�G�f��c{,�;I �C.`i g�i��,�� CONTACT EMAIL: ��;L d�,..���-i���c,�e-�i ,�'- C�,� � �Pa� -,��' � .-_ ,v,N,.r�F <br /> AGREEMENT:I herehy certi(y that 1 have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances governing this type <br /> of work will be compleled whether specilied herein or rroL The granting ol a permit does not presume to give authority to violate or cancel Uie provisions of any othei state or <br /> local law regulating construcfion o�the performance of constiuction. That I am authorized by the ownerof fhis property to perform the work fo�which applicatron is made and 1 <br /> comply with the State Contractois Law 18.27 RCW and 296.200 WAC. <br /> ��'" City of Everett ONiciaf Use Only <br /> �;% : <br /> �,� PERMIT# <br /> ,;.: � �;�� E � � �,Z <br /> , � � �_ ����_E �,� <br /> 0 n�YlAuthoriz�d AgenYSignature Date (Revised 9/23/2016) <br /> o' <br /> � <br />