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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> iJ PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: B�C� . C 75th St. SE Everett, WA 98203 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS:N/A ❑COMMERCIAL <br /> USE OF BUILDING: MUItI-FaIl11I Residential <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 800.00 <br /> NUMBER OF DEVECES if low volta e): � <br /> FIRE ALARM? 0 YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> �EscRiPTioN oF wottK: Provide dedicated 120V circuit for new fire alarm panel. <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReer <br /> CI1Y STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: .JOI1C1S011 EI@Ctl'IC, �C1C. <br /> coN-r�cTOR,ao�Ress: STREET 11816 116th Street NE <br /> �„-Y Kirkland STATE WA Z,P 98034 <br /> CONTRACTOR PHONE:42�J-H2�-5226 CONTRACTOR EMAIL: JOIlf1F1 Q�JOIltlS011@I@Ct.COfTI <br /> CONTRACTOR LIC.#{REQUIRED): jOIlC1Se13H4C'U CITY OF EVERETT BUSINESS LIC.#(REC2UIRED):03�435 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4Z�J-766-7OH4 <br /> Larry Watson coNTacT enna�:larryw@johnsonelect.com <br /> AGF2EEMENT.�1 hereby certi(y that 1 have read and examined this application and know the same to be true and correct. A!l provisions of laws and ordinances governing thrs type <br /> 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 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296200 WAC. <br /> City of Evereft Official Use Only <br /> PERMIT# <br /> � ,� . E �.�--( � - C C�� <br /> Own /Au orized Agent Signature Dat (Revised 9/23/2016) <br />