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qLECTRICAL PERMIT AAICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITEINFORMATION <br /> PROJECT CRESS: � � � � e. <br /> BUILDING AREA(if residential,new construction`,remodel,or addition) <br /> BUILDING TYPE: 0 SFR-DETACHED b SFR-ATTACHED O DUPLEX 0 MULTI-FAMILY-#OF UNITS: C&COMMERCIAL <br /> USE OF BUILDING- V- + <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONT CT"PRICE OF d RK: �( <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? ®YES MINO <br /> A SSOCiATELI BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: t 0 , <br /> IQ <br /> CONTACT INFORMATiON <br /> POWNER <br /> ME: ,_ ENANT NiINIE(If Commercial): <br /> ILING ADDRE SS: STRM e yJ CMy V G STATE A--C}NE: C9 1 IER EMAIL: y y o, Cl ov, r y <br /> CONTRACTOR NAME.- ta <br /> yr nq <br /> CONTRACTOR ADDRESS: STREET �/ } � <br /> CIT9` STATS Zip' �7 F t/ <br /> CONTRACTOR PHONE: c1'0 LO CONTRACTOR EMAIL: PAM 12 Ail�c f V� t r <br /> CINTRACTOR LIC.#(REQUIREt7): <br /> PRIMARY Ct3NTACT: E!C?�1NER [�j,CONTRACTOR CI OTHER(Please Specify} <br /> AGREEMENT:Thereby certify that f have read and examined this application and know the same to be true and correct. Ail provisions of laws and ordinances governing this <br /> type of work will be completed whether specified heroin 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 l 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 /> LiFEE <br /> CCI <br /> PERMIT <br /> -- r <br /> OwnerlAuthordaed Agent Signature Data (Revised 1011212015) <br />