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May 16 16 09:48a Accomplish Electric 360-863-6511 p,2 ILECTRICAL PERMIT A ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E)eve retleps@everettwa•gov I www•everettwa_gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: (^ V2 Q A BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: D SFR-DETACHED SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCWL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ E' %-Y-=� NUMBER OF DEVICES if low volts e FIRE ALARM? ❑YES O ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: \I' `^ ^O Q1 TENANT NAME if Commercial): OWNER MAILING ADDRESS: STREET r •- CITY - STAT£L•� ZIP •: �— P PHONE:`� t-1'QJ`45L A -4' WNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: 1U1STREET CfTY STATE �� Z CONTRACTOR PHONE: CONTRACTOR EMAIL ,. 2y CrA CONTRACTOR LIC. REQUIRED):�C 'rTc ' ' '= CITY OF EVERETT BUSINESS LIC.#(REQUIRED):. PRIMARY CONTACT: ❑OWNER OrCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: e. 5'V �`�\� r3 ".��•Yl�a�l�L � Y1C__:.. .7 AGREEMENT.-Thereby certify that 1 have read and examined this application and know the same to be true and correct. All prov,'•sions of to ws and ordinances goveming this type or work wX 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 la wregulating construct/on or the performance ofconstruction. That I am authorized by the o caner of this property to perform the do k for which applrcatron is made and/ comply wish the State Contractors taw 18.27 RCWand 296.200 WAC. City of Everett Official Use Only FEE PERMIT# rs Ow rlAuthoriz A n gnature Efate (Revised 90112!2075)