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INECTRICAL PERMIT AP&CATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION qqt, S PROJECT ADDRESS: cyr® �` lY ((� IA4 fo BUILDING AREA(if residential, new construction,remodel, or addition) 2—qz- 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 voltage): FIRE ALARM? 0 YES 1 T ❑NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: _j CONTACT INFORMATION OWNER NAME: TENANT NAME If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE I L ZIP OWNER PHONE: S47, (cj A ) OWNER EMAIL: TOOAA AS S'o-3 (.tJ CONTRACTOR NAME: � U CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR MOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �,n p CONTACT EMAIL: p�n� PSL —2 �@ e-0 M AGREEMENT:T hereby certify that 1 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 pen`ormance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WA C. City of Everett Official Use Only FEE 0 ,�! PERMITf# la • z„„ E � l o - �-�2__ Ow a/Authorized Agent Signature Date (Revised 10/12/2015)