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EACTRICAL PERMIT APSICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everethva.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: I---Foo . BUILDING AREA(if residential. neva construction. remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 2 �p NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES ❑ NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: �yc.�C<' 'D:2L Q�- 'Z _ FL,ic ur-) CX�SF� .'-i �Le- 6sor%eA4 '1'O t G 2 1.� -kr S CONTACT INFORMATION OWNER NAME:hr-ov►&CnL 7C i v-n4 AAa7e,&I TENANT NAME (If Commercial): OWNER MAILING ADDRESS: s-BEET C TY s'-ATE ZIP OWNER PHONE: / OWNER EMAIL: CONTRACTOR NAME: Y _G04 C(CCkr n CONTRACTOR ADDRESS: s-REST `O 1 / ♦ \ �/'}),/)�� /p Cry 1"L t.• CTA-F Zip 6 V(V CONTRACTOR PHONE: 2 o(a'43(6�- S20 o 1CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): V e CA Ec!912 A0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OOqh qS— PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2b(p��jSO- �:M 39 N �ScA4CT )WA(,d CONTACT EMAIL: �� o�nw�ldC v_-CCA. C-D", AGREEMENT:Thereby cer.01 that I have reed and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 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/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everei Official Use Only FEE PERMIT# ner/Author' ed Agent Signature Date (Revised 10/1212015)