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360-652-2217 0 :04:27 p.m. 06-23-2016 2/3 <br /> 1� �'' ECTRICAL PERMIT AP��ICATtON <br /> � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � (P)425-257-8890 � �AX 425-257-8857 � (E) everetteps@everet#wa.gov � www.everettwa.gov/permits <br /> =�/� � '� <br /> ' ' ' , PROJECT.SITE INFORMATION ` <br /> PROJECTADDRESS: a� ` �=� � � � � <br /> BUILDI NG Af2EA(if resldential, new construction,remodel,or addition) SF `- <br /> - BUILDING TYPE: ❑SFR-DEi�ACHED O 5FR-ATTACHED ❑ �UPLEX ❑ MULTI-FAMILY-#OF UNIT5: �COMMERCIAL <br /> U5E OF BUILDING: c,�`�j�r� � � <br /> ELECTR�CAL APPLICATiON IN�ORMATION ` ` : <br /> CONTRACT PRICE OF WORK: $ '" � <br /> NUMBER OF DEV(CES if law voltage): <br /> FIRE ALARM? ❑YES �NO <br /> ASSOCIATED BUILDENG PERMIT#(if a licable : <br /> DESCRIPTION OF WORK: � `-� <br /> � �� <br /> , <br /> ': . CONTACT INFORMATION, . <br /> OWNER NAME:� ,� ,� ' � TENANT NAME(If Commercial : — ,.� � ', �� <br /> OWNER MAILlNG ADDRESS: s�e� aS C a (`�,�_ ,� ��-' V/' -� <br /> C� ��.�-��_. STATE� ZIP <br /> OWNER PHONE: ���j' . ��'j OWNER EMAIL: <br /> CONTRACTOR NAME: � ��C �P Gp <br /> CONTRACTOR AbbRESS: srneEr P.l�. � <br /> � <br /> -� cm �� �� sTara �`' o�-�-- <br /> ZIP f <br /> C�NTRACTOR PHONE: - � � CONTRACTOR EMAIL. y ��� p ' � ��`; � -� �� <br /> CONTRACTOR LIC.#{REouIRED): � ��� CITY OF EVERETT BUSINESS UC.#(��I��O <br /> PRIMARY CQNTACT: ❑OWNER �CONTRACTOR I7 OTHER(Please Specify) <br /> CONTACT NAME: , COt�TACT PHONE: _�'- � , � <br /> V i �1�\ CONTACT EMAIL: • ' -1 �` � •_ C `.� <br /> AGREEMENT.•T hereby certi(y that I have read and examined this applrca[ion and know fhe same to he true and correct. All provisions of laws and ordinances governing this <br /> type o/work wrll be completed whether specrfred herern or not. The granting of a permit does not presume to give authority!o violate or cancel fhe provisions of any other state or <br /> local law regulating construction or the perfomrance of construction. That 1 am aufhorized by lhe o�vner of this praperty to perform the urork for which applitation is made and I <br /> comply with the State Confractors Law 18.27 RCW and 296.2oD WAC. <br /> City of Everett Ofrcia!Use Ortly <br /> FEE <br /> � f S�-.�s <br /> PERMIT# <br /> �-- ���� El6o� - l68 <br /> �wnerlAuthorizo ge t Signature Date (Revised i0/12/2015) <br />