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�CTRICAL PERMIT AP�ICATION <br /> CIN OF EVERETf PERMIT SERVICES <br /> 32Q0 CEDAR STREET, EVERETT,WA 9820� <br /> {P)42�257-881U � FAX�42�257-8857 j (E)everetteps@eversttwa;gov 1 www.everetiwa.govipermits <br /> PROJECT SITE:INFORMATlON : <br /> PROJECT ADDRESS: ��� S� �V t.��"�i /4 l�Cv Ut'�"I <br /> BUILDING AREA(if residential,new construction,remodel,or addition)��M t�()�1- SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERGIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATfdN ' <br /> CONTRACT PRICE OF WORK:s Z O�0�G�.�� <br /> NUMBER OF DEVICES if Ibw volt� e): <br /> FIRE ALARM? ❑YES NO <br /> ASSOGIATED BUtlDING PERMIT# if applicable: <br /> DESCRIPTION OF WORK: ,� �.W � (2,i�"� S I U�� 1 r� C:���T 1� c� S N EL L <br /> CONTACT INFORMATION <br /> OWNER N/UAE: TENANT NAME(ff Comr�rcial): � '� � j� i <br /> OWNER MAILING ADDRESS� srREEr � S S C�, S pi��N i (��(L1L 1.�3 ��`� <br /> CfiY Cl V�.�L ,J'1,N� 1'r\1�-IL- STATE �� � 7JP (y L S. <br /> OWNER PHONE: S,� �� �-`"f�D �1 I O OWNER EMAIL: <br /> CONTRACTOR NAME: !�1�� L(�'i:- ��,LG l 2i C, ��f-- <br /> CONTRACTOR ADDRESS: srneer `2� Z Z, �� J ( s� P E-��-� <br /> cmr � J�J�Q�,J�4 srn� ��'� Da l g��r� <br /> CONTRACTOR PHONE: ZEz(o "7 5rj '°�Ipty(, CONTRACTOR EMAIL: 1•J LL �Dfa� " >✓��rl t., C n.� <br /> ONTRACTOR LiC.#(REQUIRED):;U�,W L1�t��Z.`7�'I CITY OF EVERETT BUSINESS:LIC.#(REQ RED)� �� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Speafy) <br /> CONTACT NAME: CONTACT PHONE: 2 0� '7 ��j '�Fj Q(p <br /> tv`+h p^' O��%� CONTACT EMAIL: ;�j I,.��f�in � I�.ss+�fii-�c., a-. <br /> C c. <br /> AGREEMEN7:�l her�by ce►tily Ufat/have�ead and exami�d this appGca6on and know the same to be true and coneck AN provisions of laws and ordirtances goveming this lype <br /> of wodc will be complpted whether sper�fied herein or not The granting of a permit dces not presume fo give authorily to violate or cancel the provisrons of any other sfafe or <br /> bcal law regulaSng cons6vc6on or the perfom►ance of�ns6uc(ion. That l am autlro�ized by the owner of this qape�ty io perform U►e wo�1c for which appllcation is made and I <br /> complywith ihe State Contractors Law 18 27 RCW and 296 200 WAC. <br /> Cily of Ever�tt Official Use Onty <br /> PERMIT# <br /> ��. � , E 1� C2 -- a�-E � <br /> Owner/Autliorized Agent Signature Date (Revised 9/23�2016) <br />