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" '` aECTRICAL PERMIT AOLICATION <br /> _--_ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: (te e,7(2 A st £ire '9A 9 Sj 2P 3 <br /> BUILDING AREA ' res' ential, n construction,remodel,or addition) 4:7 6. <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: ()e fc LILA 5 A 1- c /- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRiCE OF WORK: $ 500 <br /> NUMBER OF DEVICES(if low voltage): / <br /> FIRE ALARM? 0 YES VINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> a-ep (2 67' K L " . , � .t ( r2c r ! a Hams (r vt t,.J <br /> -1-il b2 N. 37(4 (f, 1 1 <br /> . <br /> CONTACT INFORMATION <br /> OWNER NAME: fJ�e, / (A ( �S r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2/74 / G r !ley- <br /> CITY <br /> aCITY �/.�/"p� STATE 1/'"4 <br /> o ZIP Q 2.0 <br /> OWNER PHONE: (Z5 03C -Co 1,0 to OWNER EMAIL: d yq-f f-•/)/U t-( C , ie <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: 5/('A <br /> CONTACT EMAIL: ,I <br /> �AV c � i'� <br /> AGREEMENT'T hereby certify that l 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 fo perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE C <br /> PERMIT* <br /> 5/ ( f E 465 -- U <br /> 0 er/Authorized Agent ignature ate (Revised 10/12/2015) <br />