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ELECTRICAL PERMIT APPLICATION 40°111: CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3 O&' A-1 V e 5oyi 6 I. vol �- BUILDING AREA(if residential,new construction,remodel,or addition) r6Lj t ('t SF 41 BUILDING TYPE: kI SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMIL -#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ IC, 06C ,00 NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES XrNO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: t� r- L i f c=. c- f S F . "- (C p)c' CG Cad O°o el - CONTACT INFORMATION,. OWNER NAME; C,trA TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 362j -� /��Sd� 1✓d L^ CITY 6-V t..a. STATE jej/r ZIP 1 kr:2 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: /��u fa E c�lr t CONTRACTOR ADDRESS: STREET 14a.,q A'v& D 5L CITY :51/ta dr-A. %,51.1 STATE Lilt ZIP I C 3C 1(/ CONTRACTOR PHONE:(4„)5-0(4,3 -'j' CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):Art.,J 86 - (_ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER (CONTRACTOR 0 OTHER(Please Specify) .., CONTACT NAME: CONTACT PHONE:0,20 •7—7 6 1�1 (9 c 5 CONTACT EMAILAe` ,-a tEE I c cf i( nc Q aCa Sl— 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• r101 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 local law regulating construction or the performance of construction. That lam authorized by the owner of this properly to perform the work for which application is made and 1 comply with the State Contractors Law 98.27 RCW and 296.200 WAC City of Everett Official Use Only FEE 5 0 ---- PERMIT# Owner/AuthoorizedAgent Signet Date (Revised 10/12/2015)