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' ELECTRICAL PERMIT APP1JC��AATI <br /> mCITY OF EVERETT PERMIT SERVICES <br /> midg3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: t-i n l2-D <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED E)-SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: . S`lij)-4-1-\-•(__- - � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: A O -L-0R-1' 't ,,,.,r\- `--I <br /> SOD {d-- ' -- e^0's- <br /> CONTACT INFORMATION <br /> OWNER NAME: (fie TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3e G} <br /> Q CITY F-1/�'� -\ STATE ZIP I B Z� <br /> OWNER PHONE: LSA-- U — Ce li(/ OWNER EMAIL: • - ' <br /> CONTRACTOR NAME: - ; ----- <br /> )u •-tt iL 1 F(----ft----Th( <br /> CONTRACTOR ADDRESS: flREET!7jgTK S"1--S,-t,1 ' <br /> CITY LikE J11...•&cam STATE ' • ZIP (7)'P7).'`,7,' , <br /> CONTRACTOR PHONE: (. o C., E3St, 9 C8 CONTRACTOR EMAIL: . <br /> CONTRACTOR LIC.#(REQUIRED): <br /> ". ' • CITY OF EVERETT BUSINESS LIC.#(REQUIRED): . <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: J LI0ati CONTACT PHONE: . • r <br /> CONTACT EMAIL: <br /> AGREEMENT:I 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 <br /> 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 I 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 Law 18.27 RCW and 296.200 WAC. <br /> ® City of Everett Official Use Only <br /> E 1 '601 -0°1 & <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />