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0 • <br />ELECTRICAL PERP I T APPLICATION <br />(P) 425-257-8810 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 j (E) everetteps@everettwa.gov I vwuw.everettwa.gov/permits <br />fPllB®JEOTI' SITE OM(;m®llgMATl'B® <br />PROJECT ADDRESS: CCL15Y V <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED Pl SFR ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: I1,�'"�� -L I %i (--7 <br />ELECTRICAL APPLROATdON 91N FORMATIOM <br />CONTRACT PRICE OF WORK: $ j l7G f <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: ;4pv M `e' T va c(� of T-CWAJ40^4,e5 - aDRcS5 <br />CONTACT 1INFORMATION. . <br />OWNER NAME: ( L(11 TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY STATE ZIP <br />OWNER PHONE: �%�'� " C ' 3 OWNER EMAIL: <br />CONTRACTOR'NAME: i'� N'Tf �CeC7�Tt I C LL <br />CONTRACTOR ADDRESS: STREETIli . V <br />�(Q <br />C] <br />CITY „S'n%'v1"fOi�i / S I STATE �/li 1 ZIP / qOp� Z -1 O <br />CONTRACTOR PHONE: zr 7'dg -7 t 32- <br />CONTRACTOR EMAIL: �eP✓r��eL eCT2 I C 1 C C'"rvC.- Cow( <br />CONTRACTOR LIC. #(REQUIRED): F{N'>—eeL"5r-r" � <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 5-77 W L4 <br />PRIMARY CONTACT: N OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: 1,12.E 7 571 7/ 3 Z <br />CONTACT EMAIL: FA.,7--etLetectrzIC ��G..r� rc CiJv✓1 <br />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 <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 />I <br />� 4c" I0r� <br />thorized Agent Signature Date <br />City of Everett Official Use Only <br />FEE <br />00 <br />PERMIT # <br />E (So t l=2— <br />(Revised 1011212015) <br />