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0LECT'RICAL PERMIT AWLICATION <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: "�f ((?�',� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) E O C SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: FrCOMMERCIAL <br /> USE OF BUILDING: I-11 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): ! <br /> DESCRIPTION OF WORK: _ T d /� L F,� Z e <br /> CONTACT INFORMATION <br /> OWNER NAME: u)olI'e4an 62 �Lf� TENANT NAME(If Commercial): <br /> 1 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE 71P <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET V <br /> CITY 5 LJ STATE _V ZIP 61 <br /> CONTRACTOR PHONE: g 7Q CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR' ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: q2,5— 76062 1c/ 7 <br /> vyl WL —1:;nt 'I 64 <br /> d CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that I 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 /> j <br /> PERMIT# <br /> Owne uthorized A t Wignature Date (Revised 10/12/2015) <br />