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E�E�TRICQL PERMIT A�P�i�ATIQN <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: '"�J�J� SV� �i���CT (�t�'1�L �'�� <br /> 6lii�DlFiG AREA(if r�sidentiai, new constructiun,remo�,ei,ur addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACNED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ,�COMMERCIAL <br /> USE OF BUILDING: �-�%�•�` �/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ I O�i <br /> NUMBER OF DEVICES if low volta e : -' <br /> FIRE ALARM? ❑YES 1�N0 <br /> ASSOCIATED BUILDING PERMIT# if a licabie : <br /> DESCRIPTION OF WORK: i(�I ''T�IsL 1��`�j� X :��`�, �� �-D I—I—VIM T� 1 <br /> � � - � - � � <br /> CONTACT INFORMATION <br /> OWNER NAME:Q��(��} /kL Vl{E�(('� �� j�(� TENANT NAME(If Commercial): �%�S IG-�(� Y--� y � <br /> OWNER MAILING ADDRESS: srReer � �'� '� M <br /> cirv ��/'�" �C( STATE �'V ziP vI. �� <br /> OWNER PHONE:i� � - OWNER EMAIL: �1�1 i -L"1,�1, " � (°''� G'f.V� (.�(� •. ( () <br /> CONTRACTOR NAME: Mlkl � I ry � Q �� "'- S ' � � � <br /> CONTRACTOR ADDRESS: srReer � � � <br /> citv � -�'j sTnre z�a ��'✓�,��' <br /> CONTRACTOR PHONE: � " ;�-{- �� ��j � CONTRACTOR EMAIL: j���11. � '` � �'"�:1�i�r�1,�� :.s � !' ., � /1 <br /> CONTRACTOR LIC.#(REQUIRED):S ��7:��C�bj`�(�', , CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �f`�(i�� � <br /> PRIMARY CONTACT: ❑OWNER _ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ' a _ �— `�i <br /> r/1..�c'fil��- �(✓��-r✓�- CONTACT EMAIL: ,r'Vll1 I��>w" �S Y)�r�'� !1��'�i�Vl -C�T' � <br /> AGREEMENT:!hereby certify that 1 have read and examined this application and know the same to be true and correct. A!I provisions oflaws and ordinances governrng 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 cancet the provisions of any other state or <br /> local law regulating constructron or the performance of construction. That 1 am authorized by the owner of this property to perform the wo�k for which application rs made and l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Ciry of Everett Official Use Only <br /> PERMIT# <br /> , � E � , � -, �.� �,-�, <br /> � :�. � <br /> Owner/Au orized Agent Signature Date (Revised 9/23/2016) <br />