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OLECTRICAL PERMIT AOWICATION <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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECTADDRESS: 3(16' doz6x <br /> BUILDING AREA(if residential, new construction, remodel, or addition) ��4� SF /f�Qp <br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: GS <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ OC <br /> NUMBER OF DEVICES (if low voltage): O <br /> FIRE ALARM? Z YES ❑ NO <br /> ASSOCIATED BUILDING PERM #(if applicable): <br /> DESCRIPTION OF WORK: /!/R4lH 6-ew e- I0 <br /> CONTACT INFORMATION <br /> OWNER NAME: ' .4Rd -55V8,5 / TENANT NAME(If Commercial): O4/-0 <br /> OWNER MAILING ADDRESS: STREET / / f 1441 d-5- 1111F- <br /> 114 <br /> 1/L� <br /> H ,111/ CITY /qS G STATE k-4_'CZ4 ZIP <br /> OWNER PHONE: OWNER EMAIL: 1400 �5'T.gG6�r <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 71 <br /> 479, <br /> iJ �j <br /> CITY STAT ZIP % O'� / <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTA AME: CONTACT PHONE: J <br /> ,fi2� CONTACT EMAIL:,� �'��i►666�-Z. Q �y,Q/�/ .LD <br /> AGREEMENT. Thereby 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 <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 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> E lcoc2 — � � <br /> Owner/Authorized Agent Signature D to (Revised 10/1212015) <br />