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360-652-2217 02:04:27 p.m. 06-23-2016 2/3 <br /> 1� �' L.�ECTRICAL PERMIT APr �fCATION <br /> � <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (fP)425-257-88'i0 � �AX 425-257-8857 � (E) everetteps@everefiwa.gov � www.everettwa.gov/permits <br /> ��/� � `� .� ' <br /> , <br /> ., ; _. <br /> , <br /> ` = , :: _- PROJECT-SITE.',iNFORMATiON : __ : - <br /> PROJECTADORESS: c�� " �� � �� � <br /> BUILDI NG AREA(if residential,new construction,remodel,or addition) SF `- <br /> - BU1L�iNGTYPE: ❑SFR-pETACHE� ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#O�UNITS: �COMMERCIAL <br /> U5E OF BUILDING �'�j��� � -� <br /> ELECTRtCAL APPl.1CATlON IN�ORMATION <br /> .. ., , . . , . . .. .... . ....... ... <br /> _ <br /> CONTRACT PRICE OF WORiC: $ '� � <br /> NUMBER OF DEViCES if law voltage): <br /> FIR�ALARM? ❑YES ❑NO <br /> AS50CIATED BUILD}NG PERMIT#(if a licable : <br /> DESCRIPTIONDF WORtC: �' �-� <br /> � L�3-- <br /> , <br /> ' ` ` ' ' CONTACT�INFORMATION, - <br /> _. . . . ... . _. <br /> OWNER NAME:� ,A .� ' � 'FENA�IT NAME(lf Commercial : — � �� <br /> OWNER MAILING ADDRESS: srReFr �S C a � (-�p_ ,� �F= V/` -� <br /> CI7Y ����'-S�._. STATE L.J�J� LP <br /> OWNER PHONE; y�-rj . �� OWNER EMAIL: <br /> CONTRACTOR NAME: � ��C � '(_,_� <br /> CONTRACTOR ADbRESS: srnEer P.C_�. . <br /> 1 �� i'�� ��Y STATL � <br /> �� ZIP C �� <br /> CON7RACTOR PHONE: CONTRACTOR EMAIL. y ��� p ` � ,¢��,y � -� �� <br /> CONTRACTOR UC.#(REQUIRED): L ��� CITY OF EVERETT BUS[NESS LIC.#(��[� `Q <br /> PRIMARY GONTACT: ❑OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTAGT NAME: , CONTACT PHONE: _�� a , �� <br /> V l �1�l� -_ CONTACT El4AAfL: • , �y �� W� �' C `'� <br /> AGREEMENT.-T hereby cenify thaf I have read and examined this application and know fhe same to 6e lrue and correct. Afl provisions of/aws and ordrnances governing titis <br /> type o/work will be completed whether specrfied herein or not. The granting of a permif does not presume to give authori(y to violate or cancel!he p�ovisions of any other sfate or <br /> local law regulating consfructlon or the perforrnance of construction. That 1 am authorized by fhe owner of this property to perform fhe work for which application is made and 1 <br /> comply with the Sfate Confractors Law 18.27 RCW and 296.200 WAC. <br /> Gity of Evereft O�cial Use Only <br /> FEE <br /> � � ��•� <br /> PERMIT# <br /> �---- ���� , E 160� - I�8 <br /> OwnerlAuthorizo ge t Signature Date (Rovised 10/12/2015) <br />