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ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATIONI', PROJECT ADDRESS: I`O I e v ELK-Plet BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: S VA M I UMW Wen ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 2-IM) NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES _#NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: Oj ltg LOOM /� 1 CONTACT INFORMATION OWNER NAME: KA V. Vt �/t� Vl S Q TENANT NAME If Commercial): OWNER MAILING ADDRESS: STREET , �-�c��}/ (� CITY Eve(l'/^V W �/STATE v� ZIP KL OWNER PHONE: 1 U Ut OWNE1R/EMAIL: Yv CONTRACTOR NAME: o +"e -- �� V(ecCe)( / , L ool. CONTRACTOR ADDRESS: STREET D lq- V G S r l CITY^ f/ S STATE A14 p ZIP �J CONTRACTOR PHONE: 2'✓/Z ,'f — ICS/� CCO�NT� (kq RACTOREMAIL: l�� ( �N7 CONTRACTOR LIC.#(REQUIRED): - v(iE7(5/� -C l/�,9Z' CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER _20NTRACTOR ❑OTHER(Please Specify) CONTACT NAME: / CONTACT PHONE: CONTACTEMAIL: AGREEMENT.I hereby certify that 1 have read and examined this application and know the same to be true a46orrect. All provisions of la s 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 law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 2E Ij OwnertAidthorized Agent gnat re bz6ate (Revised 9/23/2016)