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�CTRICAL PERMIT AP _ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 ( (E) everetteps@everettwa.gov ( www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: aaa C-1 BUILDING AREA(if residential, new construct t 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: $ NUMBER OF DEVICES if low vojta e - FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: C'c € x CONTACT INFORMATION OWNER NAME: "7�,�.�,u TENANT NAME if Commercial): OWNER MAILING ADDRESS: STREET •y�K, �,,� l CIN STATE "' ZIP OWNER PHONE: � < OWNER EMAIL: CONTRACTOR NAME: ( CONTRACTOR ADDRESS: STREET �CfTY STATE t ZIP i CONTRACTOR PHONE: d_r�-� CONTRACTOR EMAIL: . �., CONTRACTOR LIC.#{REQUIR) Det �t CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: . CONTACT PHONE: L — � CONTACT EMAIL: 4GREEMENT.•Thereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordt araces governing this 'ype 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 ocal law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I ;omply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Oficial Use Only FEE 'r 'l_5 . M � PERMIT# owner/Authorized Agent Signature Date (Revised 10/1212015)