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ELECTRICAL PERMIT AID LICATI® <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.gov 1 www.everettwa.gov/permits <br />PRO,JE /T, SITE IN CItIlIIATIOieI <br />PROJECT ADDRESS: 'Q ir`f C q-Si o Y© zC� <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />[USE OF BUILDING: & / ry <br />_. <br />EL.EGTRI_it APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ E ao <br />NUMBER OF DEVICES (if low voltage):' Lt <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: l &3b+A-L t;4,% y G 4-V G11 rL(r, i S S �tcr� S _ uwcLr <br />CONTACT INFORMATION . <br />OWNER NAME: <br />TENANT NAME (if Commercial): <br />OWNER MAILING ADDRESS: <br />STREET PO 60)d 3'70'7 MS 614 "40 1 <br />Crry ( STATE W 4- ZIP g (?-Lt <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: ex- <br />t WX 14,�' - <br />CONTRACTOR ADDRESS: <br />/� {� <br />STREET 44(t 3 C A L 4" &G IL <br />CITY A yedko STATE �{� ZIP J UZ7 <br />CONTRACTOR PHONE: ZCy. -35.E-- �1C1b(d <br />1CONTRACTOR EMAIL: -r4-51,vvS ��2��� ro a✓►- �i' � c c'�' <br />CONTRACTOR LIC. #(REQUIRED): <br />, - - L, C,T - D �5 <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 5i5TYI <br />PRIMARY CONTACT: II OWNER <br />w rc%CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />` v-,u-- <br />CONTACT PHONE: 2 0( r3 3-11� (o <br />CONTACT EMAIL: ems Q <br />AGREEMENT.. Thereby certify that l 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 otherstate or <br />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 is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature <br />/ZZ-- �'/ / 9. <br />Date <br />City of Everett Official Use Only <br />FEE <br />��- C7'0 <br />PERMIT # <br />i got-- rr-7 <br />(Revised 1011212015) <br />