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E ',CTRICAL PERMIT APF �ATION <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 f= r'{�Gl�-'� �Gs�� �R <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 /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �O� <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: Re ���.2 r � � e 4' �2 <br /> CONTACT INFORMATION <br /> OWNER NAME: /f Bl�C,� /�i`� TENANT NAME(If Commercial): � �rc <br /> OWNER MAILING ADDRESS: srReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: SD�1n�t' � G/.�vi/7.-e'y ,� !' <br /> CONTRACTORADDRESS: s�eer �'/L- �,� l�f�e ��'iG/ <br /> CITV �(/��i (/� STATE G✓� ZIP /�Z�� <br /> CONTRACTOR PHONE: O ' 7" J 7dS CONTRACTOR EMAIL: �'llJ�. �� 5���-SS�hC � ��� <br /> CONTRACTOR LIC.#(REQUIRED): Spd�S� S G T / CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O � <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �.p 6 � y � 3�/,�j` <br /> �GLtI'e �CL�',�"C CONTACT EMAIL: ��f.0 � � SO/Jiiv� ,�/�1 E � � .h <br /> AGREEMENT:1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owne�of this property to peNorm 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 Everett Oificial Use Only <br /> .� <br /> _--7'";' <br /> J.-- -� / .' � - PERMIT# <br /> �� <br /> �� `���� <br /> �' E <br /> ' � i, l-Z% Z� 3 �� ___- <br /> Q� ner/�jifhorized Agent Signature Date (Revised 9/23/2016) <br />