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• • <br />ELECTRICAL PERMIT APPLICATION <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 www.everettwa.gov/permits <br />PROJECT SITE INFORMATION:' <br />PROJECT ADDRESS: 44vkilffa ppf��wwew�/y7 y �' v <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: dr*.r r4c4* l." <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ Q 640 U . <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? 0 YES 0 <br />ASSOCIATED BUILDING PERMIT # (if applicabl2L <br />DESCRIPTION OF WORK: <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): jDo21 su.li3OW} <br />OWNER MAILING ADDRESS: STREET a47 30 We�v i' <br />CITY Fveylerr STATE Wk ZIP <br />OWNER PHONE: 4 OWNER EMAIL: <br />��— <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET Z 5 <br />yA(j' <br />CITY STATE IAI • ZIP q l <br />CONTRACTOR PHONE: - %� -^ Q(,� CONTRACTOR EMAIL: i-1F/.�1,40.vd <br />CONTRACTOR UC. #(REQUIRED): (r fCITY OF EVERETT BUSINESS LIC. #(REQUIRED): G11"r <br />PRIMARY CONTACT: ❑ OWNER XCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME, <br />M��/�� <br />CONTACT I <br />��V <br />CONTACT EMAIL:' <br />AGREEMENT: 1 hereby certify that l have read and examined this application and know the same to be true and correct, All provisions or laws and ordinances governing this type <br />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 regulattng 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 t <br />comply with the State Contractors Law 18,27 RCW and 296.200 WAC, <br />Digitally signed by Drew Mackey <br />Drew DN: cn=Drew Mackey, o=Evergreen <br />Power Systems, Inc, ou, <br />Macke email=dmackey@evergreenps.net, <br />c=US <br />Date: 2018.08.24 15:33:48-07'00' <br />Owner/Authorized Agent Signature Date <br />City of Everett ORiciat Use Only <br />PERMIT # <br />(Revised 9/73r2016) <br />