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.ECTRICAL PERMIT Al LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www,evereltwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �'�Oil C�►L�i-1'l+' ) �/ DiD0 1g'\L r e--)V cn' <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: S R-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDIN : �i1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: S <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: � �1a �FDr p2(�D � <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Ll& 1n1/1-k)(_� <br /> CITY STATE LIP <br /> OWNER PHONE: �� , OWNER EMAIL: ttpS�__5:�" Io@1 <br /> CONTRACTOR NAME: C_' <br /> CONTRACTOR ADDRESS: sTREETa k /ZJ� � Jf: <br /> CITY STA^TE� ` ZIP !/0 V <br /> CONTRACTOR PHONE:+ " 3 CONTRACTOR EMAIL: , Gore", <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 3-7 <br /> PRIMARY CONTACT: NER NTRA ❑ OTHER (Please Specify) <br /> CONTACT NAME: \ CONTACT PHONE: — <br /> �` � 1�► ��/�,�r�,ey(-Z CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 I 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E 22 <br />