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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 INFORMATION PROJECT ADDRESS: Q� tom' BUILDING AREA(if residential,new construction, remodel, or addition) SF [BUILDING TYPE: FR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 0 ,coo NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if a licable): DESCRIPTION OF WORK; 110Vll— IdAklt CONTACT INFORMATION OWNER NAME: TENANT NAME if Commerclal : OWNER MAILING ADDRESS: STREET 0 aICo J Cnv STATE WA ZIP OWNER PHONE: W�`7 "7 q OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET Qd CITY STATE A ZIP 201 CONTRACTOR PHONE: CONTRACTOR EMAIL Merl y}r1 CONTRACTOR LIC.#(REQUIRED):t.,,X he �1 -Id1A ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT (N'�A,yI .M,.�E:: CONTACT PHONE: 359 0-3 ` `t 11 f ( CONTACT EMAIL:rmn" �► AGREEMENT.,I 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Oficial Use Only PERMIT# Owner/Authorized Agent Signature Date (Revised 9/23/2016)