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ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 I (E)everetteps@everettvva.gov I www.everettwa.gov/permits PROJECT SIToJNFORMATION PROJECT ADDRESS: 411&07 (Vesf' Vitui Dr- BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE:,SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: zzEL,041111000,Ptiehtritia,, MOON CONTRACT PRICE OF WORK: $ .5 , NUMBER OF DEVICES(if low voltage), FIRE ALARM? ❑YES ! NO ASSOCIATED BUILDING PERMIT#(ii applicable): DESCRIPTION OFWORK;_ . RefIGL ar3 OWNER NAME: j1 Ud1rw'f TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4(07 + Vfeu Dr CrrY S 4 STATE ' f Zia g # l OWNER PHONE: 41‘.15 3i7 c17 3.7 OWNER EMAIL: CONTRACTOR NAME: Xr t hsz.0.11'cQ CONTRACTOR ADDRESS: STREET t �Q CITY .C„"':o4 VS 1 `� STATE WA' ziP (13 20 CONTRACTOR PHONE: 1.-?P5- q OCAb CONTRACTOR EMAIL: d C e C-Nnk@r)..-4-re't CONTRACTOR LTC,#(REQUIRED); CITY OF EVERETT BUSINESS LIC,#IREQUIRED). 1C,0 CIS PRIMARY CONTACT: 0 OWNER pi,CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: y CONTACT PHONE: L- 5 R5c1 I �(� CONTACT EMAIL: c # , (00 AGREEMENT:I hereby certify that i have read and examined this application and know the same fo be(rue and correct. Ail 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 slate or local law regulating construction or the performance of construction. That I am authorized by the owner of thts property to perform the work for which application is made end I comply with the State Contractors Law 18.27 RCW end 296.200 WAC. City of Everett Official Use Only PERMIT# Owner/Authorized Agent Signature � Dale (Revised 9/23/2016)