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ELECTRICAL PERMIT APPRATION 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 ADDRESS: t V 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: ,3 ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ Soo9 NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES *NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: - Dowt/ C014"1`AC"1' 1H#6k6WA*1ON OWNER NAME: WA '' .VW TENANT NAME if Commerciall: OWNER MAILING ADDRESS: STREET W ff CRY v r STATE CA ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: S irvii~ r CITY STATE ZIP �3 } CONTRACTOR PHONE: CONTRACTOR EMAIL: Y . ) t N , C CONTRACTOR LIC. REQUIRED): I_x L IL41 NA CITY F EVERETT BUSINESS LIC.#(REQUIRED): Q2256S PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) v CONTACT NAME: q IV) CONTACT PHONE: _� E° CONTACT EMAIL: 1 0 Ckk, C„ ,coy — 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 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 low 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 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE � PERMIT# f p ne 3 ) �-1 Dq' 0 41A,th. E Agent LI Signature Date (Revised 10/1212015)