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»ECTRICAL PERMIT A LIGATION <br /> CITY OF EVERETT PERMIT ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential, new construction, remodel,or addition) /lam SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: S i=pe <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` �/ <br /> DESCRIPTION OF WORK: / 26 r'Cu 7a hr ,/&w /V <br /> . <br /> CONTACT INFORMATION <br /> OWNER NAME: d�����e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET % --Qu J <br /> CITY l-� STATE 6 ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1-/j/-�-- Lq ZlkjoC AWk <br /> CONTRACTOR ADDRESS: STREET/- <br /> I S T rU - ) �y <br /> CITY /`�- r,� STATE ZX-b' <br /> 4 ZIP /�2Z <br /> CONTRACTOR PHONE: 3�(i —QS / r CONTRACTOR EMAIL: Ur/I09��f tC <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER 10CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ONTACT PHONE: -G� <br /> IlKoe /L G,� CONTACT EMAIL: <br /> 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 <br /> 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 <br /> 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/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />