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06?20/2017 07 : 40 42308 P. 002/002 • • ELECTRICAL PERMIT APPLICATION CITY OF EVERI=TT PERMIT SERVICES 3k00 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FP4 425-257-8857 1 (E) everetteps@everettwa.gov I www.everet".gov/permits e PROJECT SITE INFORMATION PROJECT ADDRESS: 6 41 BUILDING AREA(if residential, new construction, remodel, or addition) Sr BUILDING TYPL: ❑SFR-DETACHED ❑ SFR-A ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS; ❑COMMERCIAL USE OF BUILDING: SF ELECTRICAL:APPLICATION,INFORMATION CONTRACT PRICE OF WORK: $ SdicJ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES ❑ NO ASSOCIATI=D BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 1E P.( LLlIZ70 12 eLIA e CONsT^ACT INFORMATION OWNER NAME: tT�i�Q �s TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET Le N S—f s[.') CITY-EffAUT STATEJ�tAZip / �d OWNER PHONE: �-2— OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET Q" I.?/ cm srAre zip CONTRACTOR PHONE: Lal 13/ )-2 f CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRER);Fl"L /VfSf Y1 Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED)--d l4 J 6 PRIMARY CONTACT, Q OWNER ❑CONTRACTOR M OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 13'-'NN CQPVtJ Uf dtr fte!eCONTACT EMAIL' AGREEMENT.I hereby comity 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 complotod whether specified herein or not. The granting of a permit does not presume to give autharity 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 tlso Only PERMIT# ner/Authorized Aflent Signature Date (Revised 9,122/2096)