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• of77- (P) 425-257-8810 N i a CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS; BUILDING AREA (if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ C',o� NUMBER OF DEVICES (if low voltage): ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME; A TENANT NAME (If Commercial OWNER MAILING ADDRESS: STREET �(��+t ® �, �J 2C) CITY Q l.M��l.✓ STATE ZIP 8� OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 4P. � CONTRACTOR ADDRESS: STREET 6()( tt_J V CITY STATE ZIP CONTRACTOR PHONE: lA - k' C) CONTRACTOR EMAIL: ' CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: -"L, w CONTACT PHONE: tX0. LOLA iL-') CONTACT EMAIL: AGREEMENT. Thereby 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 16.27 RCW and 296.200 WAC. Owner/Authorized Aaent -�� /g Date City of Everett Official Use Only FEE 411510 PERMIT # E hj �oq - (Revised 1011212015) V