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ELECTRICAL PERMIT APPLICAT[ON <br /> CITY OF EVERET7 PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q'! <br /> (P)425-257-881� � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> y;:.✓ PROJECT SITE'[NFORMATION <br /> PROJECTADDRESS:�t %; ���� ��;� ; <br /> BUiLDING AREA(if residential,new construction, remodel,cr addition) I �:��{ SF <br /> BUILDtNG TYPE:�FR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: ,J���f��in��y� <br /> " ELECTRIGAL APPLtCATION INFORMATtON <br /> CONTRACT PRICE OF WORK: S ;�q�.('�, <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �(�:i�2,� i N'lri i^rGiF I�t��;�` �'^ S�n� t'� •��a-- ��1"; �4�;'l;',P;t� ('t O,a it; .,�'�;t����:�� <br /> /� ^ t �' � � v -�' <br /> l��i�'_ ��L7 !1^-':���-?('l f�,�<;�2� �t-'�.� � ` �• '.� <br /> o - � <br /> CONTACT 1NFORMATION <br /> OWNER NAME: ;'V"y��-r��7 s�; j�,T�, R,;,��� 7ENAtVT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-ReEr x����% �,��,;� 3� jj�/ <br /> cm� f'1/T':�(Z';�� s-rnre �;11 r� zia �j .,�X,�'�� <br /> OWNER PHQNE: ����-�s�� ��,�"�� OWNER EMAIL: <br /> CONTRACTOR NAME: �-� �C, �; �r����;�}� <br /> CONTRACTOR ADDRESS: sTReEr ��(�G, ��� 1�,'- �S t�Q <br /> CI1V � �I�:Y���'� STATE }IV�� ZIP �ki+�1 <br /> CONTRACTOR PHONE: •-�{-;�,\� �f)1,n; -'�^��� CON'TRACTOR EMAIL: �d'�,�/�, � ����.(l�-)-�,n� . ( �';n� <br /> CON7RACTOR LIC.#(REQUIRED;:���i`(��� �;,t�€�t�, C1TY OF EVERETT B S1NES5 LIC.#(f',�QUIRED):���{G�;��X,� <br /> PRIMARY CONTACT: ❑ OWNER �ONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1��`_j,�'';�- �(,i��-� <br /> S�'�,'�' '����('�� CONTACT EMAIL: � � �r ,� /� �rf 'i�1����' , ( i�i�v,, <br /> AGREEMENT:!hereby certify that 1 have read and examined this application and know the same to be true and corre�t, A!1 provisionsDYrlaws and ordinances goveming this iype <br /> of work wi;l be completed whefher spec�ed herein or not. The granting of a parmit does not presume to give aufhonfy fo violafe or cance!fhe provisions of any ofher stafe or <br /> local!aw regufafing construction or the performsnce of construcfion. That 1 am aufhorized by fhe owner of ihis properfy to perform the work for which appli;ation is made and I <br /> comply with the State Contractors taw 18.27 RCW and 296.20C WAC. <br /> City ot Evereft O�cial Use Only <br /> PERM17# <br /> .�!��i ,� ,�1�.�.�' �-��-i� E ��� � _' � I <br /> Owner/Authorized�Agent Signature Date {Revised 9/23/2016J <br />