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E :CTRICAL PERMIT API L-CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982011 <br /> (P)425-257-8810 FAX 425-257-8857 (E)evere#"@everettwa.gov I www.everettwa,gov/perm is <br /> ��.'t R .R � o \ <br /> Eml AA <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: E319FR-DETACHED M SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: © COMMERCIAL <br /> USE OF BUILDING: <br /> ,.y <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? 13 YES C1 NO <br /> ASSOCIATED BUILDINGS PERMIT# if applicable): <br /> DESCRIPTION OF WORK: Z <br /> r <br /> OWNER NAME: r TENANT NAME if Commercial): <br /> OWNER MAILING ADDRESS: STREET � ' <br /> Grry sTATEzipOWNER PHONE: <br /> ;� -- �� OWNER EMAIL: <br /> CONTRACTOR NAME: =_ 7C <br /> CONTRACTOR ADDRESS: STREET <br /> cRY .. STATE kA Zip <br /> CONTRACTOR PHONE: _ TRA�TOR EMAIL: ` a <br /> CONTRACTOR LIC. REQUIRED?; �fi . ry - CITY OF EVERETT BUSINESS LIC.#REQUI ,;9 <br /> PRIMARY CONTACT: 0 OWNER M16ONTRACTOR (CI OTHER(Please Specify <br /> CONTACT NAME: <br /> 6t."�i. r-� WS k�" .` CONTACT PHONE: <br /> CONTACT EMAIL; <br /> AGREEMENT:T hereby oert fy that 1 hays road and exarrrined this application and know the same to be true and waact. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The grenftrtg of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local taw regulating construction or the perforrrrance of construction. That t am authorized by the owner of this property to perform+the work for which application is made and f <br /> comply with the State Contractors Law 18.27 RC W and 296.200 WAG. <br /> City of Everett Official Use Only <br /> FEE J .._.. <br /> PERMIT# <br /> Ourner/Ai(ithorized Agent Signature Date (Revised 1011212015) <br />