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6P-i,►/ .woe 1 o 6 5 c ti4err r, ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov k www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: / 1/ 2.14 4-1-) wo_ gSn4 BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE:76FR-DETACHED ❑SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: / 1 Dovf Acz_ ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ - aU► QQ NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YESNO ASSOCIATED BUILDING PERMIT# le : (if applicab DESCRIPTION OF WORK: 72/ZO 1 fiL/r!p. Po U' %(4 Mo v ( t EVER T- CONTACT INFORMATION OWNER NAME: C VRU�j - TENANT NAME(If Commercial): rev/2_ Cr ik5e-v/ � OWNER MAILING ADDRESS: srRerr C35W 0/� J� C 2f7 Cn,Y II(�okf r�L I TY STATE kAi f- . ZIP q / OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET ,472-3 i . MA-K.4 NAL. i/i//'i T Sd ' ,�y�( / cry 1 STATE � �� ZIP ' V CONTRACTOR PHONE: 206- 774f- c6 CONTRACTOR EMAIL: 7)�11�G 7/Yp E/ ,t) , , E-7 CONTRACTOR LIC.#(REQUIRED): £,E S P5 'SO 1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 OWNER IXCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2_06O6 _ 5 1 3 7 Zo 7%l ' 1 '/1r t G al DL-5" CONTACT EMAIL: RlylCQ 2i )6--- ,a2.61e12,2AA, Na" AGREEMENT:t hereby certify that I have read and examined this application and know the same to be true and correct, All provisions of laws and ordinances governing this 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 local law regulating construction or the performance of construction, That am authorized by the owner of this property to perform the work for which plication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Digitally signed by Drew Mackey City of Everett Official Use Only cnMackey, EvergreenDrew Mackey Power Systems,Inc,ou, PERMIT# email=dmackey@evergreenps.net,c=US Z� I Date:2018.03.01 13:03:29-08'00' E ` v l J Owner/Authorized Agent Signature Date (Revised 9/23/2016)