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kLECTRICALPERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ' jZ (� {} <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX m.-MULTI-FAMILY-#OF UNITS: nCOMMERCIAL <br /> USE OF BUILDING: Q(y-<A'••�fy%tY <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ,,}24cfJ ----- <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? IQ YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: <br /> ( If's <br /> CONTACT INFORMATION <br /> OWNER NAME: `�'�� �� k� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY l_..v C- "lit;- STATE r_r\-;p-Y;_ ZIP <br /> OWNER PHONE:,2 • 2cfu . r A OWNER EMAIL: <br /> CONTRACTOR NAME: t-,\,) <br /> CONTRACTOR ADDRESS: STREET ZA <br /> �(A-(.. ,_: STATE ZIP rhK' <br /> `J <br /> CONTRACTOR PHONE:41-S. �`.�Jl�X�tt CONTRACTOR EMAIL: �- <br /> c Lu :Y1 Ci-) - C <br /> CONTRACTOR LIC.#(REQUIRED)7 ';1.1„{ /; ;n. -Ly, ` CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNERe179 CONTRACTOR ❑OTHER(Please Specify) �`YO <br /> CONTACT NAME: CONTACT PHONE: Lc:)� C -C�,C }1l <br /> O �l <br /> CONTACT EMAIL: <br /> AGREEMENT:Thereby certify That t have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority 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 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 /> \ PERMIT# <br /> ✓�-C' Vt.S�- L.r � � O E <br /> Owner/Authorized Agent Signature Dale <br /> (Revised 10/12/2015) <br />