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► <br /> ELECTRICAL PERMIT APPLICATION <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�I " � 'T4�C <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: I�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 ❑ PIO <br /> ASSOCIATED BUILDING PERMIT#(if applicab�e): <br /> DESCRIPTION OF WORK: i ��CJ�%t��4 � C-,jL�%�L=-�� '� �'�(Z G� <br /> l.�.�' <br /> 'l�f 1t,'c:� L,� ��L, � :.�. <br /> CONTACT INFORMATION <br /> OWNER NAME: ,'Y� 1a)�L� "�f��:'�? I— TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT ��7 �r - t�'�G--P 1�� � <br /> cirv �.-���%'�-- STATE L%�, na i��', <br /> OWNER PHONE:('-CL":� �G'�% - `T Z� ' OWNER EMAIL: <br /> CONTRACTOR NAME: (,,,�L�(„� r lC(�:L_:;l� L�U`� -- �/� �- �1 / <br /> CONTRACTOR ADDRESS: sTReeT G I �-C' r��- c:._- <br /> arv � �iL--�--.;.y.r srare L �/� r zia �� �Z f�� <br /> ! <br /> CONTRACTOR PHONE: 7�Z�S 1 Z`<�Z- -3/�y CONTRACTOR EMAIL: ���"���'.���y��'-�-- �G�l'!�1 <br /> CONTRACTOR LIC.#(REQUIRED): ''���. ��'�'����;� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): !� � <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: r, CONTACT PHONE: (�Z� `J�--�j('-� <br /> j�.�,�1,��_��u CONTACT EMAIL: �j,��,�;�,/L��/;�I/��_ �!i;,^-�, <br /> AGREEMENT.•I hereby certify that 1 have read and examined this application and know the same to be true and correct. A!1 provisions of laws and ordinances goveming this fype <br /> of work will be completed whether specified herein or nof. The granting of a permit does not presume to give authority fo viofate or cance!Ihe provisions of any other state or <br /> local law regulating construction or the performance of const�uction. That!am authorized by!he owner of this property to perform 1he work for which appfication is made and I <br /> comply with the Stafe Conlractors Law 18.27 RCW and 296.200 WAC. <br /> '! City of Everett Official Use Only <br /> ti / <br /> � PERMIT# <br /> �� l �/� �� _ )� <br /> �� -i�t�-1 7 E �+ ' ' �' �i ^ � <br /> ; �_ � ; <br /> OwnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br />