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LECTRICAL PERMIT AP ACATI®N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 ( (E)everetteps@everettwa.gov www.everettwa.govtpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2 V <br /> BUILDING AREA(if residential,new construction, remodel, or additionL 1VQ SF <br /> BUILDING TYPE: 11 SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX O MULTI-FAMILY-#OF UNITS: 2150-MMERCIAL <br /> USE OF BUILDING: sZK61 i / <br /> `c� / AJ <br /> ELECTRICAL APPLICATION INFORMATION ' 1 <br /> CONTRACT PRICE OF WORK.$ h <br /> NUMBER OF DEVICES (if low voltage): c) <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION ( t <br /> OWNER NAME: t"tU • A& ftlq ;1' TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: sTReET �i e {�} <br /> CITY ' STATE ZIP <br /> OWNER PHONE: rj 1 1OWNEREMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> f <br /> CITY - STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(R IRED): <br /> PRIMARY CONTACT:,.OWNER ❑CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: C � PHONE: <br /> ` dCONTAGT <br /> CONTACT EMAIL: <br /> AORFEMENT.•T hereby codify that 1 have read and examined this application and know the same to be litre and conect. All provisions of laws and ordinances goveming this j <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 cencel the provisions of any other state or <br /> local law regulating construction ortha performance of construction. That f am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 98.27 RCW and 295.200 WAC. <br /> City of Everett Official Use Only <br /> FEE � <br /> ` PERMIT# <br /> dE <br /> J <br /> Owker&githorlzed Agent signature Dae (Revised 90/12/2015) h <br /> 3 <br />