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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: ` �{ t`Spn Ave— v 2 (�JA- 9✓�2.1 2 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: ter ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ az NUMBER OF DEVICES (if low voltage):0 FIRE ALARM? ❑YES O\N0 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: �Eii_s1s ai a C 02 A-A .2y6v CM '4 (r utn rd 7 cele- CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): ry /UIQ r OWNER MAILING ADDRESS: STREET CITY STATE Zap OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: &AAar Loc"&Lict L.L(L- CONTRACTOR ADDRESS: STREET IS q4'1 ,4ve— E QQ CITY (A G,jl� STATE t4 ZIP U-37 CONTRACTOR PHONE: 995 ICONTRACTOR EMAIL: aW rt a C C/ CONTRACTOR LIC.#(REQUIRED): ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):S$79� PRIMARY CONTACT: A OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: S66- 4'7 -1995 RCiv 'SA'rr__'v\ CONTACT EMAIL: � AGREEMENT.'T hereby 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/am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE �_(� , '5C PERMIT# 9 23�?vl� E 0 9 t �- Owner/Authorized Agent Signature Date (Revised 10/1212015)