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��ECTRICAL PERMIT APF��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.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: � ��,,5� ,%YI T � `��E'.tA� �'f�1� <br /> BUILDING AREA(if residential, new construction, remodel,or addition) 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: $ Z Q ,�, �'iC� <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES �NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: i � QC U? P e � 2 � <br /> � ��. � ' -�' P � � e ' t <br /> Q, e� ' <br /> CONTACT INFORMATION <br /> OWNER NAME: A� O� � v Q YV� N�' ( ): Tr� � 2'C�Irn <br /> TENANT NAME If Commercial <br /> OWNER MAILING ADDRESS: sTReer 0 Z <br /> � <br /> CITY �/ ^' �'� STATE � ZIP � Z�J <br /> OWNER PHONE: YZ S""�� /'�.3�I OWNER EMAIL: <br /> CONTRACTOR NAME: � � �/U <br /> CONTRACTOR ADDRESS: sTREEr Z� � Ke, <br /> CITY STATE �,/� ZIP � � � <br /> CONTRACTOR PHONE: �Z�v -�'Q � CONTRACTOR EMAIL:�Q�� @� I/1�,�VL/\ <br /> CONTRACTOR LIC.#(REQUIRED):�� /V� �� � CITY OF EVERETT BUSINESS LIC.#(REQUIRED):DJ'��,��� <br /> PRIMARY CONTACT: �OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZCJ `S�� '"�QZ �� <br /> �� � �(,YL�Z CONTACT EMAIL: ��� D�� '�J ,��y)/'l <br /> AGREEMENT:I hereby certify that/have read and examined this application and knowthe same to be true and correct. All provisions of/aws and ordinances goveming this type <br /> of wvrk will be completed whether specified herein or not. The granting of a permit does not presume to give authonty to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the�nrork for which application is made and I <br /> comply with the State Contracfors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> I�' PERMIT# � <br /> ��� E � � �- ���, <br /> �� � l/-����� v � � � � <br /> O ner/Au ed�ent Signature Date (Revised 923/2016) <br /> �I� <br /> 4, <br />