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� � ELECTRICAL PERMIT AP�LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: f p �15 V/C f.� � BUILDING AREA(if residential, new construction, remodel, or addition) `1 �L SF BUILDING TYPE: �SFR-DETACHED ❑ SFR-Al7ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ST— ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ��NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: ��' t t�t_l� 1< ��Lj-� ��j CONTACT INFORMATION OWNER NAME: r7� r' � �' �� TENANT NAME Qf Commercial): OWNER MAILING ADDRESS: s-rReer � � j/;r' :s.3 '��-� CITY CJC/\�'� STATE I�-�� ZIP Q Z,� � OWNER PHONE: �,� Z.CC,-- ('-� Q OWNER EMAIL: CONTRACTOR NAME: G� "y�J( �'(,.(i�.t R,j l� C `v� ((�C. CONTRACTOR ADDRESS: sTREET S/5 u��P ,�( CIiY �✓�� STATE �{� ZIP ,�L� CONTRACTOR PHONE: y�,� ,3G� –�(� 3 CONTRACTOR EMAIL: CV��.17' �.i..CC,i �C C C�M�i(�. CONTRACTOR LIC.#(RE(1UIRED): I�L�( '�L.O113 1V S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C13�i 3�/U PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) CONTACTNAME: �� .G�� CONTACTPHONE: y�� ,j�� '��.3 CONTACT EMAIL: S� AGREEMENT:T hereby certify that/have read and examined this applicatron and know the same to be true and co�rect. All provisions of/aws and ordinances governing this type of work will be completed whether specified he�ein 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 construcfion or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and I comply with the State Cont�actors Law 18.27 RCW and 296.200 WAC. Crty of Everett Official Use Only FEE �f� ;�� PERMIT# 9 - r � - r � E , �,� -=i�;, :��; � � -� Owner/A�orized ntSignature Date (Revised 10/92/2015)