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�CTRICAL PERMIT AF _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.everetfinra.gov/permits <br /> PROJECT SIT'E INFORMATION <br /> , <br /> PROJECT ADDRES� �� �v�� . -�-�''�.'.-��d�'�/ �_� /r�r'�`J" ���,;��fi <br /> . <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE;�O"'�SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ , j ��• � <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: C'_-/l���'t'� ��������j /� ��� ll��-��;Y'�`c`� <br /> � �°�•� ��-'� <br /> . <br /> CONTACT INFORMATION <br /> ��;- � �,v � <br /> OWNER NAME: �'-�'��-�/1 _ ��-`//�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�xeeT C_�( �--+'�"�`r�''� �t � <br /> CIT' �:-�'(,/�%��7/I STATE L'� ZIP ,��� <br /> OWNER PHONE;��.1�- -' , � - � , OWNER EMAIL: . �z=+F�'7"�:�i� , �v ��� /'�'1Gyi . C.L`�`� <br /> CONTRACTOR NAME: �'l`�• �.��.��-��'�� �� �"""�l���_ �.. 1���� <br /> CONTRACTOR ADDRESS: s�eeT � ��` � � � �- - � v� � �T <br /> CITY L—�/"Y��`�M���� STATE �i'�(�y/ ZIP 4( .�� •'(r <br /> CONTRACTOR PHONE: � � ' T"'� - �a�'�° CONTRACTOR EMAIL: �` ��' Gt.� ; �' _,��:_'�I� � "'`- .C�� <br /> CONTRACTOR LIC.#(REQUIRED):/�!� �"' ��1-> �r— (;��' ��. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C:� j ~ � � <br /> PRIMARY CONTACT: '_O�IVNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � ���, ---- , ; �� � . <br /> �r°;��"✓1�'� `� <br /> '"..�-'�` � CONTACT EMAIL:��������-� �sL. i?�'�-,t..�z�"�r�' z�y'"'L. <br /> :���- <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 laws and ordinances goveming 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 performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Conhactors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �_� � � <br /> PERMIT# <br /> a <br /> � �-� �r E � ' �'���- ����% <br /> � <br /> Owner/Aut rized Agent Signature Date (Revised 10/12/2015) <br />