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�CTRICAL PERMIT AP _ICATION <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: I,� �S ���rZ{"�- ���1 L�,� _S��t�, � <br /> ` ., ,. <br /> BUILDING AREA(if residential, new construction, remodel, or addition) ..G 5 �'u SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: F:�T ri�i � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �J �5,� ��iJ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �'C� (;; �, ` c�;�e� ;,�v� rJ�JL , .� F� 11 w� S 'r'''���c's u <br /> U�'�� ��.�h ����� <br /> CONTACT INFORMATION <br /> r- ,. <br /> OWNER NAME: �5�,:1 �j�,� - �; �- TENANT NAME(If Commercial): ,[:,i,(W�/`,:� ��1� " <br /> OWNER MAILING ADDRESS: srReer (S ,1`1�y ��t .S�- #�l Z ���:I�yX` S(:�1�S li�l�e�� l.✓�� `!'Y�•'�� `t <br /> CITY �L I I L V� STATE �� ZIP b✓� �j� <br /> OWNERPHONE: ��%�� OWNEREMAIL: ;�;��� <br /> CONTRACTORNAME: '� ��r� 5 ��n� <br /> CONTRACTOR ADDRESS: sTReeT ZZ � Y S ?r�� �"i/� �, ��� <br /> cirv �a '•, <br /> �L ✓�, STATE �-, ZIP ( � �,� t� <br /> '-� <br /> CONTRACTOR PHONE: ��"I�:� ' �7 7 - C� CONTRACTOR EMAIL• ��=��=`�-�~='�FT��- °`�'` � ='�� `' ;`��� {`�% ��,�"l <br /> CONTRACTOR LIC.#(REQUIRED): �G'l��I� F'`�,� �� I'`�t � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): u4���� <br /> PRIMARY CONTACT: ❑ OWNER �(CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z,.j (,� ._ T S � - �7 � S <br /> �G�v i Gl /', �a d CONTACT EMAIL: �a f'i� 5.��� � ���'.^� " s f'�'�'vl� � l���tl <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 governing 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 I am authorized by the owner of this property to perform 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 Official Use Only <br /> PERMIT# <br /> ���� ��,�'�- ��� - Z7�� � E i� ��-2�� <br /> , <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> �Z-) <br />