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I <br /> -ECTRICAL PERMIT A ILICATION <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: LZZ-7C 5 7 5-71- <br /> BUILDING <br /> lBUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE:"�I SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ -7 O <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES IZ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: 2-ooA- ww)c.Q c,"n YVlt+i- c,"e-t <br /> CONTACT INFORMATION <br /> OWNER NAME: ,C.� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: tIAP i�r <br /> j e-L I L o <br /> CONTRACTOR ADDRESS: STREET �(��� ry7—(� t/�(j' T <br /> CITY �/�� ri / / STATE // ZIP ✓� <br /> CONTRACTOR PHONE: p� <br /> �6� 7.t7- - �/ CONTRACTOR EMAIL: �/�FG / <br /> CONTRACTOR LIC.#(REQUIRED): UJ�/ rL.-T!f 71 AJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER 1�9 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: VI/�-"y PpPit}LYJ CONTACT PHONE: 2260 <br /> CONTACT EMAIL: -.57 LIC-:'C-J-1�1LC7�. C� <br /> AGREEMENT T hereby certify that l 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/am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> .`00 0b <br /> PERMIT# <br /> Owner/Auth d Agent Signature Date (Revised 10/1212015) <br />