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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: ;°{,��� ,i ���
<br /> BUILDING AREA(if residential, new construction,remodel, or addition) '��-��' }I����� SF
<br /> BUILDiNG TYPE: �SFR-DETACHED ❑ SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: y"� ��� �'�,K.:�"�;'��
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK: $ , �c t�> '`•
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if a plicable :
<br /> DESCRIPTION OF WORK: '"'-i,�skk?�, I'�.:+r,�>, ° f i J`r3�= M..:� _�/ .�v - � .r�>:�►;�:= ��'�», _..
<br /> �,• lC.� ��P' 4�%'.X� "� .fs";Y—�7i.ul�GC�I �.`"�71�i./f.�— /�`��C- �•Y'Gs'°'--.� .5 /" L:/` Cl.�fi�.;,�
<br /> CONTACT INFORMATION
<br /> OWNER NAME: �,_;,:'d,�,:c; ;.,,_;.^(.� `-= TENANT NAME(If Commerciai):
<br /> OWNER MAILING ADDRESS: srReer jG��� �; i�`:'
<br /> CITY �(/'��L�i / STATE L-�'�a ZIP � Z,C''J
<br /> OWNER PHONE: ZC�C=. j S.�• Z.���3 OWNER EMAIL: �J I t=11 �Jc'r`'fc. �'� .b� � ,"�<r;I. <'�^'?
<br /> CONTRACTOR NAME: �u�`�r ' < ,�: = % i iL rC, L C.C
<br /> CONTRACTOR ADDRESS: sTReeT `'�� 22-/5� S w•
<br /> CITY �'1 G���C.-.fJ.��(:" �'/t�-�°} .� STATE i--lJ.+, ZIP /��--'`/.3
<br /> CONTRACTOR PHONE: �j , .SG j �'C'�J�-' CONTRACTOR EMAIL: d �..e ct,�,�',n-,<,,,:i �' r•�,f-�:t,� . c c':-'�
<br /> CONTRACTOR LIC.#(REQUIRED): ,1✓�C'(.y�Lf j(;''L r _;'�';t CITY OF EVERETT BUSINESS LIC.#(REQUIRED): "j�:, (�,�,3
<br /> PRIMARY CONTACT: C]OWNER �CONTRACTOR ❑OTHER(P�ease Specify)
<br /> CONTACT NAME: CONTACT PHONE: y� S'� _� �z'��'�(
<br /> ����'C�� /�'./�t�f"�✓��°'�.� CONTACTEMAIL: d'e-ie c:.� �,�a<',� y''� - ,•
<br /> /�t�,�"� c.c%a'�-r
<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this
<br /> type of work will be completed whether specified herein or not. The granting of a permrt does not presume to give authority to violafe or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Officia!Use Only
<br /> FEE
<br /> � �V�� i��
<br /> ,
<br /> ;� .
<br /> PERMIT#
<br /> �C..�' .�' ._._____.._�..,____ _ �
<br /> __�- ��/C, r'� E ` (���j- `�>
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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