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-LECTRIC ill= PE MITA P 1lCATION <br /> _ l <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ( (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> P1 eJ JE:O`T SM`TE_ONF'RIfJiIA`M1ON ... <br /> PROJECT ADDRESS: 1-,a Oft'VC i v ✓ej 5O2c/ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> C CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO QQ <br /> ASSOCIATED BUILDING PERMIT it(if applicable): v 1 ® 5- O 7 <br /> X DESCRIPTION OF WORK:L <br /> P�/%4 y 1v! i`� 'I t S4ir 7 Gh In A e GJ c/e <br /> :,: :. :.-:00N0CT1NFOR114AT10N. ..:. <br /> OWNER NAME: o ocIn e7 `Zi,'1,�O<jTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> °(% <br /> PERMIT# <br /> 4 / .� F k bdp- I�c� <br /> 0 •uthorized Ag ignature Date (Revised 10/12/2015) <br />