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*LECTRICAL PERMIT A LICATI® <br /> OL Iii <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 /> PROJECT ADDRESS: }�,� <br /> BUILDING AREA(if residential, new construction' remodel,or addition) SF <br /> BUILDING TYPE: 11 SFR-DETACHED ElSFR-ATTACHEDElDUPLEX ,MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ j b\,xC6 1--cl <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? T j YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): ;-I 1;4:" <br /> DESCRIPTION OF WORK: _ . LC.�A\✓�3c�. { � f� �.1� � I � �Cx f <br /> to �, 1�C �✓e�� cvC; <br /> V'1 CA <br /> CONTACT INFORMATION <br /> OWNER NAME: 1\1\ C b\ ---(AAS � ,�, , TENANT NAME(If Commercial): <br /> n <br /> OWNER MAILING ADDRESS: STREET F—)Z �:) <br /> CITY �'�- t STATE ` ) ZIP G , d.. <br /> OWNER PHONE: 4 2Z • 2� - OWNER EMAIL: <br /> CONTRACTOR NAME: >J <br /> CONTRACTOR ADDRESS: STREET Zk` 0LG-;�` <br /> (f• <br /> cirY `-' � t...Ct.- -��'.t't'C C.C..• STATE ZIP �} <br /> CONTRACTOR PHONE: LS - `.�� � CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#REQUIRED : <br /> ( ) '�SZ4Y <br /> PRIMARY CONTACT: ❑OWNER )Ci3 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LCA�� t�, <br /> `N� y � ,Jif�.' CONTACT EMAIL: (L <br /> AGREEMENT: Thereby certify that/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 t 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 Caw 18.27 RCW and 296.200 WAC <br /> City of Everett Official Use Only <br /> FEE <br /> 666 <br /> ! PERMIT# <br /> Owner/Aut rized Agent Signature Date <br /> (Revised 10/12/2015) <br />