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IIECTRICAL PERMIT APRUCAT1®N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I vwvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��0 C 066 A ,7-t� <br /> Ve 3 pzbo f <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: XCOMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRIC4 APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3020-!t_ <br /> NUMBER OF DEVICES (if low voltage): `-'"-- <br /> FIRE ALARM? ❑YES ,NtNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: s ;CQ C C o t*ff ""IdooOtiLar <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 4vars J' <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET la 3 2 / �Q <br /> CITY `(J/'�V STATE L(/ ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: At UM Q Cfo*cQ.4,1(ler <br /> CONTRACTOR LIC.#(REQUIRED): SESI,(/ x 990 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)Lou�� <br /> 01 <br /> _._.. <br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT <br /> NAME: <br /> � / CONTACT PHONE: <br /> Axe— !/V�/l aM!' CONTACT EMAIL: r&7-A?r@ <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 296200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />