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*LECTRICAL PERMIT ARLICATI®IV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 I FAX 425-257-8857 I (E) evereiteps@everettwa.gov I wwvv.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECTADQRESS: I33,D R+:c .c Tl(, 4,,1 jvzr(4j- �A ?�zo <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - * OF U <br />USE OF BUILDING: <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ Ap600v.`f <br />NUMBER OF DEVICES if low volta e): <br />FIRE ALARM? El YES =1 NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF K: L 2 <br />W R�� c Z— <br />�'"• � o w � vet 2Z. � �C <br />�-- <br />S <br />I C6L ( _&4ice- <br />CONTACT INFORMATION <br />OWNER NAME:j TENANT NAME !f C <br />OWNER MAILING ADDRESS: STREET <br />C.r <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: V ECA E (e(�^, C r <br />CONTRACTOR ADDRESS: s;nEET <br />c <br />Za <br />— tf( L- sTAT-c 1A uQ <br />[CONTRACTOR <br />NTRACTOR PHONE: 'ZGIo -�(3(y • 7-0Q CONTRACTOR EMAIL: <br />LIC; #(REQUIRED): -CEC t_ 1(Z. aN. VCITY OF EVERETT BUSINESS LtC. #(REQUIRE }: d0(4_IMARY CONTACT: ❑ OWNER VCONTRACTOR 0 OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 7 <br />CONTACT EMAIL: �r �cr�Cclwtt}� <br />k6PEEl✓,EIJT. Thereby ce4V/ that 1 have examined this application and know the same to be true and correct. All pro✓isions oflaws and ordinances governing this <br />type la regulating <br />will be compructi vrorther specified herein or not. The granting of a permit do�� rot presume to give authority to violate or cancel the provisions of any other state or <br />Iocai law regulat ng construction or he Performance of constrUction. That I am authorized by the owner of this property ri perform the vrcancel the P appllc s on n made and I <br />ccmpiy with the State Contractors Law 1g.27 ROW and 296.200 WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />FEE <br />2- �O <br />y IE7C� <br />-oS-`�� <br />Date (Revised 101122015) <br />