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ELECTRICAL PERMIT AP (CATION <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 I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECTADDRESS: 300Z <br />Wcs(- C „tea 60zmr WW`t 620 Q' <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED <br />❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: NrCOMMERCIAL <br />USE OF BUILDING: ,lk( L <br />L US <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ 00' <br />NUMBER OF DEVICES if low volta e : N `} <br />FIRE ALARM? ❑ YES 'N NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: A I-- e L.J e- (eC.A ir1 C G2 cs r to CoL-L <br />CONTACT INFORMATION <br />OWNER NAME: i Were �L�� lT <br />TENANT NAME (If Commercial): <br />OWNER MAILING ADDR SS: STREET 3Q03 <br />e S� ! lw�u <br />CITY C..r2 {�i� <br />STATE VV4 ZIP <br />gc492_03 <br />OWNER PHONE: (p f g' - 0-;,-I C( <br />I OWNER EMAIL: <br />CONTRACTOR NAME: eLcnf-f C <br />Cpp l C <br />CONTRACTOR ADDRESS: STREET `D. <br />00 (� <br />CITY ��Q�. <br />Wjj tq� <br />STATE P ZIP <br />v( vC7 <br />CONTRACTOR PHONE: 3(00 - S `I`f - ( 4io <br />CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): �60-A ECZ 5 ` Z- /IA. <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />00 1_191t <br />PRIMARY CONTACT: ❑ OWNER 1ACONTRACTOR <br />❑ OTHER (Please Specify) <br />CONTACT NAME:*�-D"}q (a> (^_)c <br />CONTACT PHONE: <br />CONTACT EMAIL: cla v/' . ,(Ax « V e ca . cam <br />AGREEMENT.T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of 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 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 />Owner/Authorized Agent Signature <br />City of Everett Official Use Only <br />FEE _ <br />2A <br />PERMIT # <br />E <br />(Revised 1011212015) <br />