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joiow &ECTRICAL PERMIT APPLICATION MI'dalCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 ( FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SI N C IViATI®lel PROJECT ADDRES ..... �.. .. . . . ...... BUILDING AREA(if residential,new construction,remodel, or addition,. Ie?1'DF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED ADUPLEX II MULTI-FAMILY-#'iF UNITS: 0 COMMERCIAL USE OF BUILDING:C -' C...42,..--- ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 7500 NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES ANO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Coir, PU 2k:Y\jej`.iSi. y , 1 t_An,t l- fly 1i..7 CONTACT INFORMATION.... . OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:>y--- `•1QY`i�_ �-�.L� CONTRACTOR ADDRESS: STREET a.\ KJ-LAD C'1il vv,.. J,n/3) 0-_l_ CITY Vyk.ake1_?2, .-. STATE � � ZIP CONTRACTOR PHONE:a CONTRACTOR LIC.#(REQUIRED): .,9' l Lis CIT .*(REQUIRED):el g 7 Y OF EVERETT BUSINESS LIC PRIMARY CONTACT: ❑OWNER ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: J' Q 3 j '7 //57,, ` I CONTACT EMAIL: - 2 �'! 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 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 tam authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE \ C) --- PERMIT* % E S.0 L — S ( �—.�� / • , er/• orized Ages'=:—ture Data (Revised 10/12/2015)