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�ECTRICAL PERMIT APF 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 /> � � � � � �� � <br /> � � ' ��� � � � `� '� <br /> �.,,��€ U.,�� �._ ���- �,�` „� ��� � r.�� ��tx >�.v _.��; <br /> PROJECT ADDRESS:� �j ve� �t JD.� <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX �MULTI-FAMILY-#OF UNITS: ,�I COMMERCIAL <br /> USE OF BUILDING: •�-� <br /> , �. ���c��c�►°�� ��ic�rio�i�����o��"����""� � � <br /> �.�.���.. �,�,����._.��.-�..��„s.,.�-_. � ��_��_� �������._�..., � _ �. <br /> CONTRACT PRICE OF WORK:$ Q� <br /> NUMBER OF DEVICES if low volta e : � <br /> FIRE ALARM? ❑YES C�NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable : <br /> DESCRIPTION OF WORK: <br /> ���5 a ���,�. � � C�.t a U e �✓�S <br /> 11 A " <br /> CGNTACT INfO1�MATION <br /> . <br /> OWNER NAME: ` �'� p� � w,.Q t)`,n. TENANT NAME(If Commercial): ��� �cay'�� . <br /> OWNER MAILING ADDRESS: sTREer � `,)' �}2,�' �a(� �� <br /> � CIN �'Q'�e'� STATE � ZIP ���\.!V <br /> OWNER PHONE: OWNER EMAIL: � C3��(`� . " (;� y�,� ' , W. <br /> CONTRACTOR NAME: �`PO� � �V�t� <br /> CONTRACTOR ADDRESS: STREET �'�'a� ) �jf S�1 \ <br /> CI1Y � vl'�w O OC� STATE �"� � ZI P � D�b� <br /> CONTRACTOR PHONE:U� ��d� ' (�� �" CONTRACTOR EMAIL: p1 �SS le' � tr�vt f� . G`�"✓� <br /> CONTRACTOR LIC.#(REQUIRED): �b �� TF(j�lp� CITY OF EVERETT BUSINESS LI .#(REQUIRED):O (p a i� <br /> . .n. _ . _. <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) l� C� • -Fi� <br /> CONT T NAME: CONTACT PHONE: L{�.� •- 3� 3�- � I'�� <br /> ��('�F �C�� CONTACT EMAIL: '�.Q,r,� � �.2 ��`/' ���� <br /> AGREEMENT.•I hereby certify thaf 1 have read and examined this application and know the same fo be true and correct. All provisions of/aws and ordinances governing this type <br /> of work wiil be completed whether specified herein or not. The granting of a permit does not presume to give author'rfy to violate or cancel fhe provisions of any other state or <br /> /ocal/aw regulating construction or the performance of construction. That I am authorized by the owner of this property to pertorm the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Evereft O�cial Use Only <br /> � PERMIT# <br /> , �� )�- E �� o � -� c "�� <br /> Owner/Auth zed Ag Signat re Date (Revised 9/23/2016) <br />