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.ECTRICAL PERMIT A LICATIO�I <br /> T CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-881 D � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �'� � 7 � (� � L� �� �� � ��jL'� <br /> BUILDING AREA(if residential, new construction,remodel,or addition) �/:r� SF <br /> BUILDING TYPE: ❑ SFR-DET,4CHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WOFtK: $ <br /> NUMBER OF DEVICES if lo��v voltage): <br /> FIRE ALARM? ❑YE:i C�VO <br /> � <br /> ASSOCIATED BUILDING PE:RMIT# if a licable : <br /> DESCRIPTION OF WORK: �--�(Z� �L//� � D .f _ �1��, /'��`',� C� `—CT <br /> n r2�.��-�4 S�SU r_.9 T.6= %7 L.C�/,�'lGl� <br /> CONTACT INFORMATION <br /> OWNER NAME: - j� �/�S Tj� TENANT NAME(If Commercial): <br /> � <br /> OWNER MAILING ADDRESS: sr�eeT / f �����C ['� U � f}� L �}G�� <br /> CIIY `�/C STATE ZJP � �� <br /> OWNER PHONE: �CJ � - (j� OWNER EMAIL: �L I�C>�Sf� S � �'�' �m�9 '` ���' <br /> CONTRACTOR NAME: ) /U� <br /> CONTRACTOR ADDRESS: s�EEr <br /> ciTv STATE ziP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRE[)): CITY OF EVERETT BUSINESS LIC.#(RI=QUIRED): <br /> PRIMARY CONTACT: L�'.DWPdER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �' �'} •. � 3 _ D � '� <br /> ,� !� CONTACT EMAIL: � CG 5 �F !" J � � ' ���� �/J7 <br /> AGREEMENT.�T hereby certify that!heive read and examined this application and know the same to be true and correct. All provisions of Iaws a��d ordinances goveming this <br /> type of work will be complefed whether specified herein or not. The granting of a permit dces not presume to give authority to vrolate or cancel the�provisions of any other state or <br /> local law regulating consfruction or the performance of construction. That I am authonzed by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett O�cial Use Only <br /> FEE <br /> ��� ���- <br /> � <br /> PERMIT# <br /> __1���?�, � �l `lG E ���b " �' �� <br /> Owner/Authorized Agent Signature Date (Revised 10/1?J2015) <br />