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=LECTRICAL PERMIT AF"' .ICATION CITY OF EVERETT PERMIT SE::;;::;ES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 J FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: '210 4JA BUILDING AREA(if residential, new construction, remodel,.-Or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS' KCOMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ "r NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES ❑NO At ASSOCIATED BUILDING PERMIT# if a livable : x,11 6 DESCRIPTION OF WORK: L CONTACT INFORMATION OWNER NAME: TENANT NAME If Commercial): r OWNER MAILING ADDRESS: STREET CRY STATE ZJP OWNER PHONE: jj OWNER EMAIL. CONTRACTOR NAME: G G� e CONTRACTOR ADDRESS: STREET j CITY STATE UT ZIP q(O CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRE �GQ b O L� CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 3Z PRIMARY CONTACT: ❑OWNER XPONTRACTOR ❑OTHER(Please Specify) CON ACT NAME: CONTACT PHONE: 0- Q ,l }LL Y �G�e l r% iG CONTACT EMAIL: AGREEMENT.,T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of taws and ordinances governing this 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 total law regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 16.27 RCW and 296.200 WAC. �_aA (� _ (�(C n�r /� City of Everett Official Use Only �'�/ ! V�'J"�`--` FEE X 21 PERMIT# JUN - 2 2016 E ('VV7_ OZ-5 Owner/Authorized gnature Date (Revised 10/1212015)