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ESECTRICAL PERMIT APIWICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits /l � / PROJECT SITE INFORMATION PROJECT ADDRESS: !q � c7elb777777, gzoI BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHEDSFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: 1 --eWV, ? ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ yCOC) NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: a 1- "&- rl h / G / Pi St/1'l1'I G� GtG7GC i/'1 C'�i V i 2itGt G7 CONTACT INFORMATION OWNER NAME: e� /! �'� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 11- ! �om'V/0 C!/ V`/ ' 1 1b �I'✓2 CITY /a Y STATE ZIP (/Lw / 1 OWNER PHONE: 2 5)34 —2`l 3 OWNER EMAIL: Nl t� CONTRACTOR NAME: 1k, HvuSe ,f'-�ry eeS, /vf CONTRACTOR ADDRESS: STREET 16'30 fph 02 L�E 1CITY !v vY/J STATE ZIP I O kj CONTRACTOR PHONE: ��l2GJ/Z✓ ! D�I CONTRACTOR EMAIL: G(r�G�S 1 vi I�J�GS��`eGf/y►Ci• ��/ CONTRACTOR LIC.#(REQUIRED): !Jv �S �Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0/�gliv9 PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: C CONTACT PHONE: CONTACT EMAIL: k__6L�4r&111e.S4L0 AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true an correct. All provisions of laws nd 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 performance of construction. That/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 WAC. City of Everett Official Use Only PERMIT# Ow rlAuthorized Ag ignature Date (Revised 9/23/2016)