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RECTRICAL PERMIT APPICATIC3N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ( (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 02l Z 9 Hol 7— AyG 1.14 W <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: L,,00?43 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ .5_10 <br /> NUMBER OF DEVICES if low voltage): 7- <br /> FIRE <br /> FIRE ALARM? YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# if a livable : <br /> DESCRIPTION OF WORK: T.+�'tL /fz7.4 ('o/� Ll v�' . ej-1rce'5 /A/ 40"W;1--&Z06 <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME H Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL.: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET " /�,v.�t/'d / <br /> CITY Z! CY/t�j}i1/ STATE ,r� ZIP G 1 3 <br /> CONTRACTOR PHONE: 5,0:2 *(, CONTRACTOR EMAIL: . 6..\! iLo 1't�, C-0 <br /> CONTRACTOR LIC.#(REQUIRED): ! /W/~Aell O�PVeO) CITY OF EVERETT BUSINESS LIC. REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER A,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: y-6'-jd9 r r, <br /> AGREEMENT:•Thereby certify that l have read and examined this application and know the same to be hue 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 f am authorized by the owner of this property to perform the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> — 4- <br /> PERMIT# <br /> Ee� <br /> uthorized Agent Signature Date (Revised 10/12/2015) <br />