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09/27/2016 13: 46 #1021 P. 001/001 ELECTRICAL PERMIT APPLICATION _ CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everetiwa.gov www.everettwa.gov/permits • :P�CT:SITE•I.NFORMATION . • . PROJECT ADDRESS: 1366 MOIL PL, IC BUILDING AREA(if residential,new construction,remodel,or addition) _ SF • BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED C7 DUPLEX E7 MULTI-FAMILY-#OF UNITS; El COMMERCIAL USE OF BUILDING: �CW /WO C • L.0 = ( ELECTR CAL AP.PLICATION.INFORMATION. CONTRACT PRICE OF WOR . $ ZJ NUMBER OF DEVICES(if I. voltage): FIRE ALARM? ❑Y CI NO . - ASSOCIATED BUILDING PE` IT#Of applicable): DESCRIPTION OF WORK: /Airri91 L att.. CONTACT" INFORMATION; . OWNER NAME: 4 / TENANT NAME(If Commercial): <d /fid' OWNER MAILING ADDRESS: STREET tl 306 f� �Q CITY STATE /A OWNER PHONE: y3 CC 73'x' y- OWNER EMAIL: CONTRACTOR NAME: ; 114- / r�. b tee . IQ CONTRACTOR ADDRESS: srREer / et q Y7 CITY _ e:{/f'2./ STATE a . ZIP CONTRACTOR PHONE: 1/21 09a6d CONTRACTOR EMAIL: • CONTRACTOR LIC.#(REQUIRIDI: N .Z CITY OF EVERFTT BUSINEss LIC_#(RgCUIR ;I:Q' - S PRIMARY CONTACT: ❑OWNER El CONTRACTOR E7 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: If xi ),7/ Z,,,Z, f �Q ftm A441 (? U etc, CONTACT EMAIL: AGREEMENT Thereby certify that/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 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 1s made and! comply with the State Contractors Law 18.27 ROW and 298.200 WAC. City of Everett Official Use Only FEE PERMIT# 7//A"----------uthorlzed Agent Signature Date (Revised 10/12/2015)