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ELE�`TRICi4� �ER.IVIIT APPLICi4T'ION <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 � wwtinr.everettwa.gov/permits <br /> PROJECT SITE INFORMATIAN <br /> PROJECT ADDRESS: �j �{./ � a� � t,� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF (;I <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: $ � " <br /> NUMBER OF DEVICES (if low voltage): � <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: G ✓ '��t"S � '\/ ' ' � <br /> CONTACT INFORMATION <br /> OWNER NAME: n c_i y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTae� (� -,�� , �' <br /> G� �/, I <br /> CI7Y A STATE � � ZIP 1 1 � W <br /> OWNER PHONE: � � L— OWNER EMAIL: <br /> _ . ... . . _ . . <br /> _ . _ <br /> CONTRACTOR NAME: /�} > � y I(�, - �:, <br /> � <br /> CONTRACTOR ADDRESS: sTReEr , ; <br /> CIN �� � STATE ;;L� ZIP `� �) � <br /> CONTRACTOR PHONE: n ., ��.�`i � c.�. � CONTRACTOR EMAIL: 4/1 I �; <br /> CONTRACTOR LIC.#(REQUIRED): I� � � L/ CITY OF EVERETT BUSINESS LIC.#(RECIUIRED): �- ' � <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: •� � � • Z L _, • <br /> �� � �� CONTACT EMAIL: /�/���d (L,� .,`-�. �,j {' ' '(C'C ;^ C. r <br /> AGREEMENT. T hereby certify that I have read and examined this application and know the same to be true and co ect. All provisions of laws and ordinances governing this <br /> fype of wo�k will be comp/eted whefher specified herein or not. The granting of a permit does not presume to give aufhority to violate or cancel the provisions of any otherstate or <br /> local law regulating construction or fhe performance of construction. That I am authorized by fhe owner of this property to perform the work for which application is made and l <br /> comply with the State Confractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> � S - <br /> PERMIT# <br /> ; `. _���� E ��o?,- d1 �-f <br /> �� <br /> Owner/Authorized Agen Signature Date (Revised 10/92/2015) <br />