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ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT-SITE~'INFORMA°TION:>;:':. PROJECT ADDRESS: DOCS P I re -- BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ©MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: �`I f Q v\ CQ ELEGTRICAL:APPLICATION INFORMATION :: CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Prim 9 clot vJ ACT::INFORM OWNER NAME: \A/DAV-4 C)M 1 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr 1 • Pt 11i 54-- cr v arep2k4- STATE V V!'T ZIP 07 OWNER PHONE:Ltas-•-otS"t - Lf )5ci OWNER EMAIL: CONTRACTOR NAME: G 5 .3/4AeocPivkll CONTRACTOR ADDRESS: sTRaer cny '1 T V `7l 1 STATE VAAA- ZIP CJ x CONTRACTOR PHONE:4)—c—(l fl -14151 CONTRACTOR EMAIL:c () irrC� 5h ea-c ($ ( C} CONTRACTOR LIC.#(REQUIRED):GSH-7165 -O(1)^-Y� CITY OF EVERETT SINESS LIC.#(REQUIRED):✓ PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME:3Q ,r CONTACT PHONE: l4 �( 0_ )-S1 lX� , CONTACT EMAIL: La/0. C IQt c 1')P() Yt 0) 1�fiV✓L AGREEMENT:I hereby certify that I have 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 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 local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# •3 f E 1%C��f ° .._ OwnertAut orize• Age . •nature Dat (Revised 9/23/2016)