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0477 ECTRICAL PERMIT AFFLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2 2 0 2 QCe d C/nv>°!� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) DCi SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: J COMMERCIAL <br /> USE OF BUILDING: coqe...e__ ()f <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ / 000. c <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: ;I?e 9--rr A-e-yo cieZ 4 <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): .2..,<T-6-4 BI-95 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> r <br /> CONTRACTOR NAME: v(1 ( l' r t/I rr <br /> CONTRACTOR ADDRESS: STREET / 7i;7 AI / �r <br /> CITY {'j�t4? +10V-e-47- JigtGl<1 STATE LAIC.. ZIP �SS <br /> CONTRACTOR PHONE: 2, - CONTRACTOR EMAIL: G -' - / Try- C _ <br /> CONTRACTOR LIC.#(REQUIRED): /j ea p1 ?'7z )J - CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ElOWNER 0 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 246 "1 2 <br /> n e(/1 CONTACT EMAIL: 5e�rt'[( // '— <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 /> 2gD <br /> PERMIT# <br /> 6.-3e (6 E ( D(r I15- <br /> Owner A horized Agent Signature Date (Revised 10/12/2015) <br />