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��ECTRICAL PERMIT AP��ICATION <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: �r. =' � - � i."�1 �-F-'�N� l�T�' ��t-��P"1�tT- <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: _i..,�zzt, _+.�71`1�.�. ,�3f.*� �ti-�-,�i ��'i�'G'Ic � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z ���``� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ��f ^-`��',-�kt.i., , w �-Gx�..'1 ? f�/'-�tiif�C- � /���'�` l�l��i�. <br /> CONTACT INFORMATION <br /> OWNER NAME: % "�'ti /�,'✓Ln���Z TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer Z 3 l C- �'�� ILL��v� �(.'!� <br /> CITY �1J��i-�� STATE tJ�-l"r 21P <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ,�. '� � �(?E��•.�' C._ <br /> CONTRACTOR ADDRESS: sTReeT �� ��j`b' LJ 'Z� ��'��� JT ��/t-� <br /> ciTv L �'ti' srnTe e.•vC� ziP �CX7 `'j(� <br /> CONTRACTOR PHONE: �-� ,. �7 ��`; (�,� �; CONTRACTOR EMAIL: ��i��w.�7.,.�i F K� �C.<l� rj�;�/�'/��ILQ-��Z`� '�C+ <br /> CONTRACTOR LIC.#(REQUIRED): �.l�tX S� ��'Z'-% �� CITY OF EVERETT BUSWESS LIC.#(REQUIRED):(J4' �` ? <br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 t;�. �42�c ( �� <br /> CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of/aws and ordinances governing this <br /> type 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 pertormance of construction. That 1 am authorized by the owner of this property to pertorm the work for which application is made and 1 <br /> comp/y with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> ���� � � � � v� <br /> ! ; � <br /> //' J ,,:.�-y�` PERMIT# <br /> ' % / ____._—�y(-----�� i ' <br /> , ,,,� ---�_ _.. r.7 � y � E � �,Z� � � <br /> r � <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />