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�LECTRICAL PERMIT APNLICATION <br /> Ey 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 /> � <br /> PROJECT ADDRESS: 4-,��'�S `>t' '�L>✓�i �,�i,,t, � i ��--:< ��, � <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: (' <br /> `��'`�L'l�i.�.; � i'L•� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ It;U <br /> _, <br /> NUMBER OF DEVICES(if low volta e): � <br /> FIRE ALARM? ❑YES C,a�'NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: <br /> h <br /> -�t�� = IIC��iit'v'. D`� t� c, ��, '�,1 � Y���-y� �, ,� �nc� <br /> _ _ � <br /> � <br /> CONTACT INFORMATION <br /> OWNER NAME: ^' �,.� L'�.1�'t� (Q� (,� TENANT NAME(if Commercial): �2,.n�} i��t (t <br /> OWNER MAILING ADDRESS: srReer (p j(� l�-1 L�.7 �I�„ �' t��d�C, , ��ti� �� � <br /> .� 1 <br /> cm ti�,{;�-i G v,_c,\ STATE �� zia��L�`��� <br /> OWNER PHONE: OWNER EMAIL: <br /> p � <br /> CONTRACTOR NAME: f��� �' ; `� �l.. �P ��'�(�'' <br /> CONTRACTORADDRESS: srReeT � Cf� ( �- �j l�,.I� f:�f,'.:�:t.�l! I{-�,v ; 7 7 <br /> 11 �� y� (' � <br /> CITY 4� Vu��� C. STATE L�J�� ZIP � ) � � <br /> CONTRACTOR PHONE:�l�'y ��O -`s I C�G CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): �� j '-.`>�' `;�`J�i r'�` CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ����--Z S 7 - `�-1+'� <br /> l��L�Vt,' � ^,�� CONTACT EMAIL: Jr�/,�1,� � ;c. ,"���'v �."�rt .C t'i.�h <br /> AGREEMEN7�1 ereby certify that 1 have read and examined this application and know the same to be tru�and correct. All provisions of/aws and ordinances governing this type <br /> of work wilf be completed whethe�specified herein or not. The granting of a pe�mit does not presume to give autho�ity to violate or cancel the provisions of any other state or <br /> loca!law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which app/icatron is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E � � ! -. � /`,� <br /> � �� � � } _; . <br /> Owner/ orized nt ' atur D e (Revised 9/23/2016} <br />