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4177r _ECTRICAL PERMIT A LIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> • PROJECT,,SITE INFORMATION <br /> PROJECT ADDRESS: Z,t 6� /Trid SP1+-) <br /> BUILDING AREA(if residential, new construction, remodel, or addition) t,2-OQ SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: Ii ..MMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 4(0v ' <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? I1 ES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: <br /> (,J?Vi✓! <br /> 00,7,ye /o -n-, j)e (C S Po Y YI <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: (10/d /t. <br /> CONTRACTOR ADDRESS: STREET /220 &/ 2I-Cg <br /> CITY /66}c1,h Uh STATE Gu(�T ZIP 96/1 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: l <br /> CONTRACTOR LIC.#(REQUIRED): (7Q LII L 29 07 Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: 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 I 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 i &o z - DiS <br /> Ow .rized Age Signature _Date (Revised 10/12/2015) <br />