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WECTRICAL PERMIT A19LICATIo <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: <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS:—____ D�COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> r7 <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> F CONTACT INFORMATION <br /> OWNER NAME: _ tl- t '�.e ire f,nP, TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET A is <br /> STATF C. G"'� ZIP ` .. <br /> OWNER PHONE: `'fir .*::_ } OWNER EMAIL: <br /> CONTRACTOR NAME: c.�{' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY 0 i(/1`6L— t� f '':. i�.�C..�.-� STATE ;��C� ZIP <br /> CONTRACTOR PHONE: ICONT , CTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): U.ITL,7)EE-1 - ILTI)�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ' -'i'r 1 1 E(i' i I t <br /> PRIMARY CONTACT: 0 OWNER ®`CONTRACTOR 0 OTHER(Please Specify)___ <br /> CONTACT NAME: CONTACT PHONE: r -,� �?�I <br /> C" <br /> n\ CONTACT EMAIL: - �- -CjrL v)u[ ' � <br /> AGREEMENT.'T hereby certify that l 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 I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> Cb <br /> PERMIT# <br /> iotec :::�Z) E ioo� - <br /> Owne/Autho ized Agent Signature Date (Revised 10/1212015) <br /> I I frE� �v'Lclif( �� ��� I1 {�i't t �L� z. -,._ ►-�, . , <br />