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-ECTRICAL PERMIT AF ]CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2`7 Z ,!14 <br /> BUILDING AREA(if residential, new construction,remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: JX COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION " <br /> CONTRACT PRICE OF WORK: $ /()00 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / <br /> DESCRIPTION OF WORK: -/"Op <br /> CONTACT IINFORMATION, <br /> OWNER NAME: &0— 2 ' t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7 .��- �/z� y,!e ll <br /> clTr �\ STATE L.'C.`,- ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:CONTRACTOR <br /> L-C- <br /> CONTRACTOR ADDRESS: STREET Z q U L <br /> CIN �(,(� �,(,�� STATE r�;i ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: "-v ;L 4 ��•; �', (01'p A <br /> CONTRACTOR LIC.#(REQUIRED): Q CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: vf%� Coll <br /> a Al-a l CONTACT EMAIL: �� ,S i" H•� �' c �c%/ <br /> AGREEMENT..Thereby certify that/have read and examined this application and know the same to be true and correct. All provisions o 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 t 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />