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� � EI�ECTRICAL PERIVIIT i4PPLICAT'IOIV 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 INFORMA'f'ION PROJECTADDRESS: I� �� 1 L- ( �� _ BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ �j7� NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: �-j�:l.l�`� �i �I�k �L�_� � � �i.0�L�� 1�C�Ntr '�'�� 0 L � �� ti-r.,f L1�� CONTACT INFORMATION OWNER NAME: � {�r1 � � a ��s1.y'' TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREET 3 � � ` �%'� �� lr� y CITY 'F�/ `�` - ' / STATE W!'/ ZIP � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: L L��E� �"I � CONTRACTOR ADDRESS: srReer 6CiC�� FC,GM��!� S� CITY � ��J •� STATE � ZIP �(/ v"" CONTRACTOR PHONE: `C� '�G� S�� L� L CONTRACTOR EMAIL: V� �L�E-C;T��( �i�}-�(J��, C-v/�-� CONTRACTOR LIC.#(REQUIRED): V��L�'� �� ''�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):�S PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �� --�) - S �O �1 ��'r�� O�� CONTACT EMAIL: AGREEMENT'I here6y certify that 1 irave read and examined this application and know the same to be true and correct. All provisions of/aws and ordinances governing this type of work will be completed whefher 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 I am authorized by the owner of this property to perform the work for which application rs made and I comply with fhe State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# �n-1� - 1 E 1 � f0� 1�`�� Owner/Authorized gent Signature Date (Revised 9/23/2016)