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CTRICAL PERMIT APSICATION <br /> n 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: L cgoo <br /> BUILDING AREA(if residential, new construction,remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: `COMMERCIAL <br /> USE OF BUILDING: _140 la 1;`w 6/jaY�hG u�� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Gj ;c� U Cl) <br /> NUMBER OF DEVICES if low voltage): U <br /> FIRE ALARM? ❑YES `EfNO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: / /M yv_ I fiA- )— <br /> allLloc <br /> CONTACT INFORMATION <br /> OWNER NAME ( ( G( U TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETIoo UU r , /f2(/ <br /> G <br /> CITY 'Q STATE ZIP !�(J <br /> OWNER PHONE:G v "S'1 IUUo OWNER EMAIL: <br /> CONTRACTOR NAME: ',c�0. t%� �J/l/ l �S�O/ 61 <br /> CONTRACTOR ADDRESS: STREET 7-717 4 LEO <br /> CITY STATE tk) ZIP (y /��U <br /> CONTRACTOR PHONE: �IQ - CONTRACTOR EMAIL: I C l"M[v�• &` <br /> CONTRACTOR LIC.#(REQUIRED): f qj CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OO(PCD — <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ! Z3-•46f <br /> CONTACT EMAIL: <br /> AGREEM NT:/hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 I 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 /> PERMIT# <br /> E 17L <br /> Owner/ uthorized Agent ture '�' Date (Revised 9/23/2016) <br /> V <br />