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• ELECTRICAL PERMITPLICATION <br /> C1 TY OF EVERETT PERMIT ERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 88201 <br /> (P)428-257-8810 1 FAX 425-257-8857 ( (E) everei;eps@--veretiwa.gov; v�,Nvw.everett,%la.govlperm"s <br /> PROJECT SITE INFORMATION <br /> PROJECTADDRESS: Q {moi c,t �L AuF_ <br /> BUILDING AREA(ff resider:ual, new const uc`on, re.n,ocel, or ad-di`;on) SF <br /> BUILDING TYPE: D SFR-DETACHED 17-. 5FR-Ai iACHED ❑ DUPLEX El %IULTl-FAPIciLY-=pF UNITS: KCOMNIERCIAL <br /> =USEOFBUILDING: �U►vtCrti e�e� ,5 �4e;.l�i�,1 e��S a{� <br /> LECTRICA APPLICATION INFORMA'T'ION <br /> CONTRACT PRICE OF WORK: $f-_CZ�200, <br /> NUMBER OF DEVICES <br /> if lcw✓0 age): <br /> FIRE ALARM? 11 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if-applicable): <br /> DESCRIPTION OF WORK: Csuvv� <br /> IDole— 12n .T � <br /> CONTACT INFORMATION <br /> OWNER NAME: �r�v c t�tr ; w� TENANT NAME if Commercial): <br /> OWNER MAILING ADDRESS: s -rr <br /> cn, STET_ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: VEA E Mti L <br /> CONTRACTOR ADDRESS: 9;K_F1, Tod � <br /> :,�r '�f,► S-hTa �� 2rn XPi <br /> CONTRACTOR PHONE: 2t4 CONTRACTOR EMAIL: <br /> CONTRACTOR LlC.#1(REQU!RED): z:C f�c-�.LS�f'L M L1 C_ITY OF EVERETT BUSINESS LIC.#(REQUIR <br /> PRIMARY CONTACT: ❑OWNER `Q CONTRACTOR N0 OTHER(Please Specify) <br /> CONTACLINIAME: cc {{ CONTACT PHONE: <br /> CONTACT EMAIL: �. �cc{c�cis�, c <br /> AGREEMEIV7:T he,&b ce. ' C.. �1 .CGeE'L <br /> y frfy that i hav mad and sxamr, aPprica5on and lalow the same to be true and correct A7?�visfans of laws and ordinances eo✓mirg tr,s <br /> type of work v✓s+t be com tested vjhett_=r soeaffed here(n or ray Tn5 granting of a perm t doer not presume to gfve autharrz4l tc vo12.`e or cancel the provisions of any Omer s to or <br /> locallaw t5 the St8t&Coiluction or the pe7crreace of constnrw fen. That/am aufhor&ad by;xe o r nef Of this propery to pencrm the woi*for which eppli6e on is r, , and I <br /> comply wt�'1 the State Cortrctors Lew 18.27 KCN✓and 298.20"0 WAC. <br /> City of Everett fficiai Use Only <br /> FEE ...r�. <br /> - PERMIT# <br /> zt - �� � <br /> Owner orizsd Ag tSignature <br /> ate iM'e viSed 1 rJl1^112015) <br />