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+�ECTRICAL PERMIT A�LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: y 3�..�.. �J � G Yy10 h+!' V'. BUILDING AREA (if residential, new construction, remodel, or addition) 2d O SF BUILDING TYPE: ��rR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL USE OF BUILDING: � �� 4•�'1� CONTACT INFORMATION OWNER NAME: TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srReeT• z. / �j� CITY �--(/�G %�� STATE ZIP 8 OWNER PHONE: S�� .2,5 � OWNER EMAIL: �� j�j�(. �• IPS � � CONTRACTOR NAME: CONTRACTOR ADDRESS: sTReer cirv sTaTE ziP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): _ _ _ _ _ _ PRIMARY CONTACT: C�.,Q��IER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: S* c�-� 11'K ��s CONTACT EMAIL: Sa �h.r'�� AGREEMENT: T hereby certify fhat I have read and examined this application and knov✓ the same to be true and correct. All provisions of laws and ordinances governi�g this type of work will be completed whether specified he�ein or not. The granfing of a permit does not p�esume to give authori(y to violate or cancel the provisions of any othe� state or local law regulating construction or the performance of construction. That I am authorized by the owner of this properiy to perform the work for which applicafion is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. � • L Agent Signature Date City of Everett Officral Use Only FEE �v/ " PERMIT# E ��ol- rc�� (Revised 90/12/2015)