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ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 J FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: SOL 49 2 \ , v-t5rry, 1" BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: tlfi 5FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UMTS: 0 COMMERCIAL USE OF BUILDING: t 4 `'v` ELECTRICAL APPLICATION INFORMATION„,/ CONTRACT PRICE OF WORK: $ ! 2.0 -- NUMBER -NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: f4C , Ct�N ORMATI N OWNER NAME: iY l QierV ' 'tI Ck- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ' # 49Pi y CITY � -- C . STATE 2 D ZIP CI OWNER PHONE: -2. " (,.,)t9)---47I OWNER EMAIL: CONTRACTOR NAME: " CONTRACTOR ADDRESS: S RH-r ' 2 ..re--- �g CITY STATE ( ,,,,M'"+., ZIP C1 VA CONTRACTOR PHONE: 225a 6,2C-, j JCONTRACTOR EMAIL��Y_] 1 f 1 t to R f CONTRACTOR LIC.#(REQUIRED): gvsl t [CITY OF EVERETT BUSINESS LIC.#(-EQUIRED): Lib.? PRIMARY CONTACT: 0 OWNER r4 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 255 $$ x - Sr 1 CONTACT EMAIL: j i t AGREEMENT I hereby certify that l 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 taw 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 comply with the State Contractors Law 16.27 ROW and 296 200 WAC. City of Everett Official Use Only PERMIT# Ait.,a1s ..r E - OCA Owner/Authorized Agent Signature Date (Revised 9/23/2016)