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Dec. 1. 2015 3 : 57PM i No. 6285 P. 1 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES OL 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8890 1 FAX 425-257-8857 1 (E) everefteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 15 ` q }`�, -kp BUILDING AREA(H residential, new construction,remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED L2 DUPLFX ❑MULTI-FAMILY-#OF UNITS: krCOMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:S DOD NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES kNO ASSOCIATED BUILDING PERMIT# rP applicable): DESCRIPTION OF WORK: `nH OC-k-0bQ C --v yierQ-for CONTACT INFORMATION OWNER NAME: TENANT NAME(if Commorci2l): OWNER MAILING ADDRESS: Crry STATE ZIr' OWNER PHONE: S " 525 �� OWNER EMAIL: CONTRACTOR NAME: 1=e a C CONTRACTOR ADDRESS: sTR��r 1�O.p 1 joy 3(00 Cm V\ 1 C STATE z P 3 Z CONTRACTOR PHONE: 2-5?) - O'L 1 CONTRACTOR EMAIL: Q rr6 e e R.N 2 ec. C p� G -) CONTRACTOR LIC,#(REQUIRED): G 0 6b Z,' - CITY OF EVERETT BUSIt! LIC. REc1UIRED: p'�L PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME- CONTACT PHONE: e ` , 1 e rcer CONTACT EMAIL: Q rr�l e e Q C O W e AGREEMENT:T hereby certify that/have read and examined this application and know the same be true and correef. All Provisions of laws and ordinances govem/ng this type of work will be completed whether spec#kd herein or not The granting of a Permit does not presume to give authortty to vlolate or cancel the provisions of any other state or local law regulating construction or the performance of const VCtion. That I em authorized by the owner of this property to perform the work for which applk ati0n Is made and t comply wtth the State Contractors tow 16.27 RCW and 298.200 WAC. City of Everett official usa Only FEE �1 PERMIT# GAumn O AUthoriZed Agent ignature bate (Revised 101122015)