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0 0 <br /> ELECTRICAL PERMIT L pPUGATOON <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 INFORMATI OGM <br /> P'OjECT ADDRESS: <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: <br /> ELIECTROCAL APPLICATROM INF06.PvhA u u0M <br /> CONTRACT PRICE OF WORK: $ ,S0C�,. <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: % qA <br /> k.Q--t>(�� <br /> CONTACT I FORMATOW\1 <br /> OWNER NAME: TENANT NAME(If Commercial): Qt 4 to <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: r� m � <br /> CONTRACTOR ADDRESS: sTReeTC <br /> CITY L. STATE <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): TNN O L S5N'C ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: —7m\ CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT. T hereby certify that I 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 1 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 /> PERMIT# <br /> E IbO - 6F7 <br /> wner/Authorize&Agent Signature Date (Revised 10/12/2015) <br /> �I <br />