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SECTRICAL PERMIT AVOCATION <br />CITY OF EVERETT PERMIT SERVICES E I 0 <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 INFORMATION <br />ADDRESS -loSd-5 p1LON V <br />AREA (d (esidential. new constructio,. remodel, or addition) I �,�� <br />SF <br />TYPE: ❑ SFR-DETACHED ® SFR.ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF <br />OF BUILDING: <br />ELECTRICAL APPLICATION INFORMATION <br />PRICE OF WORK: <br />OF DEVICES (if low <br />❑ YES ® NO <br />NG PERMIT # (if applic <br />ESCRIPTION OF WORK: <br />CONTACT INFORMATION <br />TENANT NAME (if C <br />❑ COMMERCIAL <br />ADDRESS sTwEET ((^�rll ll�T _I /� <br />ff t� STA _ ��j� LP <br />ci v F-_.l0 /P Tl <br />SMEE' <br />ZIP <br />cr y <br />'CONTACT: ❑ OWNER $f CONTRACTOR ❑ OTHER (Please SPecifY) <br />T NAME: CONTACT PHONE: Ll <br />CONTACT EMAIL: <br />dery Glace " <br />AGREE NT T hereby certify that I have read and examined this application and know, the same m be true and cone .All provisions of laws and ordinances any oth g this <br />to dorm the work Poi which application <br />a ,do and I <br />type of work will be completed whether specified Ilerem or not The granting of a panne does not presume to give aerty to ' to Whom <br />oblate or cancel the pmwsmns or any offrer state or <br />local Iew regulating consfrucr�on or Na peAormance o/consrrvction. That 1 um authorized by the owner of tors property Pe <br />comply wen the Stare Contractors Law 18 27 RCW and 296 200 WAC. City of Everett Official Use Only <br />FEE <br />5t0 <br />Pf RMIT # <br />EI <br />(Revved 101P2015) <br />