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ELECTRICAL PERMIT APPLICATION <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 INFORNIATION ` <br /> PROJECT ADDRESS: I C�6/� �VL�/e lwJ,/Q S <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: �,'Q P �',(j�/e,Sl�l-P <br /> ELEGTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ „�p J • 0� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ��w►pl/� �Xt 7')/�J�a YL61V S%6 �� C� <br /> i.v 17�1 L.� 7 S'7" F <br /> CONTACT INFORMATION . <br /> OWNER NAME. q) �{—p ES�ENANT NAME(If Commercial):�L�lN /`�ON <br /> OWNER MAILING ADDRESS: sTReer �Q Q �g' Q <br /> CITY � STATE � ZIP J <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �'�� J <br /> CONTRACTOR ADDRESS: sTReer �„ �.J S'�"' � <br /> CITY� � STATE � ZIP Q� <br /> CONTRACTOR PHONE:ZS3—�����75� CONTRACTOR EMAIL: CZ�L IeT.T �1SlC� _C 1M <br /> CONTRACTOR LIC.#(REQUIRED): VL �5S g�'I Z N�i CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �j <br /> __ ., � .. _. , <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: %�S3� �J�g' ����� <br /> ,Qll�s lSS� CONTACT EMAIL: S' ���y��-�-°� �L• �L <br /> AGREEMENT.�I 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � r ol � E �, ��� � a GJ� <br /> OwnerlAuthor�zed Agent Signature ate (Revised 9/23/2016) <br />