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�LECT'RIC�4� PER�/ll`� �4��LICA�'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 � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: z,� I�C�'O 1'v1.�`� (�'v' e. � e..��� W "\ Z \ <br /> BUILDING AREA(if residential, new construction, remodel, or addition) L SF <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: $ �;�(JL,' <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �- '(Z e>..J \S_C,�� cr� G � U <br /> ���'Yl� \� ��� � C v.� �� ��5 ! � G <br /> �(1 " ��-�f S � �'(� —v.�f��� �� v��-�C� ��'� <br /> CONTACT INFORMATION <br /> OWNER NAME: ,�U V�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: j� �Cm� �;���c�( � <br /> CONTRACTORADDRESS: s-rRee-r L G��� ��'�' �vJ�� <br /> i- � ` <br /> cirv �c��GiNt��� STATE � ziP <br /> —� <br /> CONTRACTOR PHONE: ZS�� -`(a�{ CONTRACTOR EMAIL: �:x L�Ov''���ZC ���, G���t1C�- �CJru <br /> CONTRACTOR LIC.#(REQUIRED): �(jV f c� �G� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):IJS��'I7i7 <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHON .1.�'�� — �� (� v <br /> � <br /> ��� � ����,�,� CONTACT EMAIL: <br /> AGREEMENT.�T hereby certrfy that I have read and examined this application and know the same to be true and correct. All provisions of/aws and ordinances goveming this <br /> type of work will be completed whefher specified herein or nof. The granting of a permit does not presume to give authority to violate or cance/the provisions of any ofher state or <br /> local law regulating consfrucfion or the performance of consfruction. That!am aufhorized by the owner of this property to perform the work for which application is made and I <br /> comply with the Sfate Confractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> � � ��fl� <br /> . <br /> PERMIT# <br /> / j� ��'�j� ,� �� ' I � � � <br /> � i l I � � �1 <br /> O er/Authorized gentSignature Date (Revised 10/12/2015) <br />