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017 <br /> ELECTRICAL PERMIT APICATON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.govwvvw.everettwa,gov/permits <br /> PRQ4ECT SITE I,NF®IFtIVIATI®M',. <br /> PROJECT ADDRESS: -3 <br /> BUILDING AREA(if residential, new construction, remodel,ora -ion) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED <br /> -❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: QE�/4G EVEjL� f <br /> ELECTRICAL APPLICATIO. I,NFORMAT904 <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES X NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORIIAATION,. _ <br /> OWNER NAME: TENANT NAME if Commercial): L G <br /> OWNER MAILING ADDRESS: STREET <br /> I N27 <br /> crry LE STATE VX/4 zipq 12 -2207 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: srREEr apo BOX <br /> cm MMK/L &') sTATM* ziP 2 <br /> CONTRACTOR PHONE: -2 0-& ` 4 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): QeN6,eC 'SAO Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED):QLIO22 <br /> PRIMARY CONTACT: ❑OWNER 14 CONTRACTOR y El OTHER(Please Specify) <br /> CONTACT NAME: I,/ CONTACT PHONE: <br /> k/ ZO�-�3b-�o5�L/pJ <br /> • N N�S Clea W CONTACT EMAIL: D� iq(S.Lt f-DW O 1�I E14 t I T- e—OM <br /> AGREEMENT••Thereby certify that I have read and examined this application and know the same to be true and correct All provisions oflaws 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/am authorized by the owner of this property to perform the work for which appffcatlon Is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE O� <br /> PERMIT# <br /> Owner Au or zed Agen Signature Date (Revised 10/1212015) <br />