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05,%1 /2016 01 : 21 #040" P. 001/001 RECTRICAL PERMIT A#LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 1 (E) everettepS@everettwa.gov www.everettwa.goV/permits PROJECT SITE INFORMATION PROJECT ADDRESS: BUILDING.AREA(if residential, new construction, remodel, or addition)---SF BUILDING TYPE: Q SFR-DETACHED Q SFR-ATTACHED XpUPLEX Q MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: 5�e oA, 44,* 41L L� NUMBER OF DEVICES {if low volta e : FIRE ALARM? ©YES Q NO ASSOCIATED BUILDING PERMIT# (f applicable)-. DESCRIPTION OF WORK: [ 10UIV r CONTACT INFORMATION OWNER NAME: AAJ TENANT NAME if Commercial): OWNFR MAILING ADDRESS: STREET /D K CITY STP.TE IAJ ZIP OWNER PHONE: LS Z OWNER IEMAIL: yrs CONTRACTOR NAME: C.h CONTRACTOR ADDRESS. sI'RUrWto I CrrY STATE zl,❑ CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRFp): CITY OF EVERETT BUSINI✓S5 LIC.#(FREQUIRED:O 3 PRIMARY CONTACT: 0 OWNER CONTRACTOR C1 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (01P ,- GDIW [ata LJL'f CONTACT EMAIL: AGR<=EMENT:T hereby corti9y 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 type of work will be Completed wh®tner 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 local law regulating construction or the performance of construction. That I am authorized by the owner of this propaO to perform the work for which application is made and i comply with the State Contractors Law 18.27 PCW and 296.200 WAC, City of Everett Oficial Use Only FEE r PERMIT# Own a.,Iz.dt Slgnature ate (Revised 10/12/2095)