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ELECTRICAL PERMIT �PLtCATiON <br /> CITY t?F EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> {P)425-257-8890 � FAX 425-257-8857 ( (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SlTE INFORMATI�N <br /> PROJECT ADDRESS: �� ,�' � ;� ��,�, �'7��.�/�} <br /> BUILDING AREA(if residential,new construction,remodei,or addition) gF <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:$ ��`,1� <br /> NUMBER OF DEVICES �f low volta e :"'� <br /> FIRE ALARM? �YES NO <br /> ASSOCIATED BUILDING PERMIT# if a licabie : <br /> DESCRIPTION OF WORK: '�j�Lz� �(��a?� ��1� �«'� �i t��.I1�1 7�ii ' - _ �t1 — TT <br /> CONTACT iNFORMATiON <br /> OWNER NAME:'�� � � j} �. "'.1"ENANT NAME !f Commercial): {ir1�'('��=�.17 i <br /> OWNER MAILING ADDRESS: sraeEr L} �/1 � <br /> C�``� •s. STATE �p G <br /> OWNER PHONE: OWNER EMAIL: . ` , �����-�-�� � • � <br /> CONTRACTOR NAME: �° � ! • � ��a <br /> y <br /> CONTRACTOR ADDRESS: srReer i"�i�,� ��� �-�(� <br /> CITY � VN STATE ZIP -{;� f�� <br /> CONTRACTOR PHONE:� �-l� '"~ �' CONTRACTOR EMAIL:�' � �' �s � � � ` <br /> CONTRACTOR�IC. REQUIRED:�� ��� � � CITY OF EYERETT BUSINESS UC.#REQUIRED: <br /> PRIMARY CONTACT: ❑pWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: • '� �. <br /> Ii�1� �C'sG��-�� CON'TACT EMAII.:• ' � � i� .^. „-� � ` ,.,1 <br /> AGREEMENT.�!heraby cerli(y that I have read and examined this application and know the same to be true and correct. A!!provisrons of/aws and adinances goveming tAi&type <br /> of work will be completed whetherspe�ed herein ornot The granf/ng of a permit does not presume to glve authority to vlolate or canceJ the provis/ons of any other state or <br /> local law regulating constn�ction or the performance of constn�ction. That!am authorized by the owner of this properiy to periorm the work for which application is made and I <br /> compty with fhe Stete Conh�ctors Law 18.27 RCW and 296.200 yyqC. <br /> Cify of Everett Off'icial Use Only <br /> ���� <br /> PERMIT# <br /> ���...- �i�i���� E I� --- L g Z <br /> owne�Autho�ized Agent Signature qate (R e v i s e d 9/2 3/2 0 1 6) <br />