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ELECTRICAL PERMIT � �! 'PLICATION <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.gav � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:✓"�"j 5� ' f�� -°� ��� ��t�-� <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: �OMMERCIAL <br /> USE OF BUILDING: - <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ , '� 1� <br /> NUMBER OF DEVICES if low volta e : '— <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if a licabie : <br /> DESCRIPTION OF WORK: ����,,` � ;a • j , � -��r, . r.- . . �- ,,�e�� <br /> � ''� �'i � ' S I s ` T <br /> CONTACT INFORMATtON <br /> OWNER NAME: .' '."'�' '�� L�,> f�.-�,C;, TENANT NAME(If Commercial): ��� - ? � <br /> OWNER MAIUNG ADDRESS: srReeT j , 0 �/ T ` , .�r' „ <br /> CITY �r I V�O. /�G� �� STATE ,l,+�l ➢P G�f � �i��' <br /> OWNER PHONE: OWNER EMAIL:S-�� -ti-�� ;v s.D .",1 . . �-�� ;-.i� <br /> CONTRACTOR NAME: ��` � '-�i j jti,j� �,(�n : - � '� <br /> �-,- ...- ,�. ,�-y� "�i�f�1 '� <br /> CONTRACTOR ADDRESS: sTReer j;� ' '� � ' <br /> ciTv �'� � " r"�L� " STATE �11G z�P ;�, �j <br /> CONTRACTOR PHONE: � q�i� �''�L''�r� CONTRACTOR EMAIL:��'W '� •< "' �" �`:';)�1 •;" � •' � .,,� <br /> CONTRACTOR LIC.#(REQUIRED):.``���=��j ���;'�J CITY OF EVERETT BUSINESS LIC.#(REQUIRED): � �;4�,� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ia(�+�'� �����;��y <br /> �rs a: <br /> M��:� i!...�C;���� CONTACT EMAIL: �., "�, ' %`�t� , •� I� f�',,� "` � <br /> AGREEMENT.•!here6y certify that I have r�ad and examined thrs application and know the same to 6e true and conecf. All provisions of ta and ordinances goveming this type <br /> of work will be completed whether spec�ed herein or not. The granting of a permit does not presume to give authonfy to violate or cancef the provisions of any other state or <br /> loca!law regulating construction or fhe performance of construcfion. Thaf I am authonzed by the owner of thrs property to perform the work for which app(ication is made and 1 <br /> comply wrth the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official tJse Only <br /> PERMIT# <br /> �� P - �� e ����ir E I� �[ — � � �—. <br /> Owned uthorized Agent Sign ture Date (Revised 9/23/2016) <br />