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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: U vl 1Y 2o'h BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHE R-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: v/l� ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ Q NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES O ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: 110 rx O OC- CITY p TENANT NAME If Commercial): OWNER MAILING ADDRESS: STREET /802 {�1 �� CITY C�V/ ?* ^/ STATE(/V ZIP OWNER PHONE: ( 25 90 —�2–rL5!/ OWNER EMAIL: N CONTRACTOR NAME: !{� ZgctliLa �( (l �f TTZ7 CONTRACTOR ADDRESS: STREET ��[7�Y f CITY Z— �.� (//�(/ Lf STATEL4 1 zip9t r �,�y,�n,, CONTRACTOR PHONE: A2(�� CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): I I V (/T�5� 2��j CITY OF EVERETT BUSINESS LIC.#(REQUIRED): l�� PRIMARY CONTACT: WNER ACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: -z12_ ) Q — CONTACT EMAIL: /V AGREEMENT.I hereby certify that I have read an ex mined this application and know the same to be true and cor ect. All provisions of laws and ordinances governing this type of work will be completed whether specified herein 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 Official Use Only PERMIT# EA 00- J_� ner/Auth ized nt Si tur Date (Revised 9/23/2016)