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*ELECTRICAL PERMIT41PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I vwvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: I-+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: $ 2'l <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ? <br /> DESCRIPTION OF WORK: RC4-6eL l frKgG GeV f- <br /> ( <br /> CONTACT INFORMATION <br /> OWNER NAME: f j- ;�i ;L�• ��j�y` TENANT NAME(If Commercial): +•E- f�„i <br /> OWNER MAILING ADDRESS: STREET <br /> Cm <br /> STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: tC� E(�tr�(,_ <br /> CONTRACTOR ADDRESS: STREET ' ice'0 <br /> CIN � L_ STATE ZIP <br /> CONTRACTOR PHONE: '2C� i43(„•j Z0C CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED) V cC. EC �+{Z 1� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0&L(9 q S <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: L:7 <br /> CONTACT PHONE: <br /> � L x. CONTACT EMAIL: <br /> AGR_EMEN7:T hereby certify that/have mad and examined this application and know the same to be true and correct. All provisionof las and odnces govmng <br /> type of work will be completed v✓hetherspecified herein or not. The granting of a permit does not presume to give authorits , rinay to violate or cancel the provisions s eithis 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Oficial Use Only <br /> FEE <br /> J <br /> PERMIT# <br /> E 03- 0q� <br /> owner/Aut oriaed Agent nature Date <br /> / (Revised 90/92/2015) <br />