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!LECTRICAL PER IIT - ICA.TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 J (E) everetteps@everettwa.gov J www.everettvwa.gov/permits <br /> PROJECT:SlidE INF:* M TION ,.::. • <br /> PROJECT ADDRESS: 17,4 H i prVe <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: .R COMMERCIAL <br /> USE OF BUILDING: ..54,st_ aa� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 3-2,v <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ittA,CL(Q_ V WtA In k1 V CttM/ <br /> . ; � � • ,_ cowl-A& • - <br /> OWNER NAME: mQ,A y,.kp��( � ✓ TENANT NAME(If Commercial): 'Tv y� v e,r H0../ <br /> OWNER MAILING ADDRESS: STREET /F{I 4 cirb1 y,� �l}V� r g <br /> '_1 <br /> CITY -U 2�(�. STATE uJ ZIP Gi S72-o‘ <br /> OWNER PHONE: (H21--) 3 r N?,UU OWNER EMAIL: no-Z- ,�tj1 -�'^ <br /> CONTRACTOR NAME: rvna.L,,.._0„ Za k e✓ <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: IIOWNER 0 CONTRACTOR Cl OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> te•.V4/\ w 2-4.eek/ CONTACT EMAIL: <br /> 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 <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 lam authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.206 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />