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`' LLECTRICAL PERMIT AH4LICATION <br /> Niiigi CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ,Q ii L/ fiCty 4- OOP- <br /> BUILDING AREA(if residential,new constructionEmode,or � <br /> dition) G 9-'<SF . <br /> BUILDING TYPE: 1:1 SFR-DETACHED 0 SFR ATTACHED LJ DUPLEX MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> � 1 <br /> USE OF BUILDING: /0_._ - `, 4 r_ r <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ S-0 <br /> NUMBER OF DEVICES(if low voltage); <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /DESCRIPTION OF WORK: !)e�(i%T C1,-,X'-/- r l e ./- .7s� c,ui 5 ) ccL .- 2-I ciit"c(ri'�o41' <br /> tj�'s."6. no pi'Ye imcAii- ps ftr"--- fr ) <br /> CONTACT INFORMATION. <br /> OWNER NAME: ,P,tie (/cTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .21 21/ 6'& _ iti- <br /> CITY Q ..,,, STATE LJ A-- zip 2 <br /> l� l an^ <br /> ll <br /> ) <br /> OWNER PHONE: 7 S *a6 /� OWNER EMAIL: erIO _ ,,,)C J.... .. �U:"-.1 <br /> CONTRACTOR NAME: [ Pf .)e I? C r/s?/ /c. ,we <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> W <br /> PRIMARY CONTACT: �U OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> . --.1 .690_____, <br /> PERMIT# <br /> 447- ?___z......______,______, <br /> E (7tl—f7 z. <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />