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_ECTRICAL PERMIT' A 'LICATION <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: '�+� � ��l�,j'�`?.; _ � �� - � <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: I�COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ , �"'��"� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES e NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: `�� E� - '� L �,-{ � �v�(��� ���; 1 E= l C) t� L �-4-1� <br /> CONTACT INFORMATLON <br /> OWNER NAME: ��} �} ��j� ��j_'��j TENANT NAME(If Commercial): G� `,r �,�L�LZ�;� <br /> OWNER MAILING ADDRESS: sTREEr `�Z.C� T�� � �`� `, (� i;� <br /> , �{ � <br /> CITY � �� ��rLl'.- STATE �, ZIP � ^ � 1� .� <br /> �. <br /> OWNER PHONE: ' '�,`�j— 7 � � OWNER EMAIL: <br /> CONTRACTOR NAME: / <br /> CONTRACTOR ADDRESS: sTREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC,#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> __ _... _... _ <br /> PRIMARY CONTACT: ❑ OWNER [�CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ���, . � _ G�,�'' <br /> �'�,�r\ �1C', � CONTACT EMAIL: �L (J�,ri�" . �' �� �C+ U�` <br /> AGREEMENT:T hereby cerfify fhat!have read and examined this application and know the same to be true and correcf. All provisions o laws and ordi ces governrng fhis <br /> type of work will be complefed whether specified herern or not. The g�anting of a permit does not presume to give authonty to violate or cancel the provisions of any other state o� <br /> local!aw regulating construction or the performance of constructron. That 1 am authorized by fhe owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> t � a �� <br /> . <br /> PERMIT# <br /> �� 2 � E ���� �' D [ `� <br /> Owner/Authorized A nt Signature ate (Revised 10/92/2015) <br />