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ELECTRICAL PERMIT V 31-ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: C t� �1 Lir `� F CL 0 G <br /> 2-0 <br /> BUILDING AREA(if residential,new construction, remodel, or addition) SF - <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: o —<wL-uS <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> L-f A16EL L r' S 2 V - <br /> CONTACT INFORMATION <br /> OWNER NAME: A74 C TENANT NAME(If Commercial): ECARO 6'A6'Al 4 <br /> OWNER MAILING ADDRESS: STREET L -C <br /> n r <br /> MyE STATE ZIP <br /> OWNER PHONE: C L4 , SL- OWNER EMAIL: C(� i C� (� �j L� C(J>--1 <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 6qT <br /> CITY T STATE ZIP l� <br /> CONTRACTOR PHONE: ��jl, �-a2Zl, CONTRACTOR EMAIL: e_k)C V- (f-Q QL 7Li <br /> rPRIMARY <br /> LIC.#(REQUIRED): �'� S S 03 3 C CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> ACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> E: CONTACT PHONE: <br /> D CONTACT EMAIL: 10" ', <br /> AGREEMENT..,Thereby certify that/have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this <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 cancel the provisions of any other state or <br /> 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 I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owned thorizedAgent Signature Da (Revised 90/1212015) <br />