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ELECTRICAL PERMIT APPLICATION 3 7T CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: `jet q e5 v et)) Dr BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPESFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 7_50 .o� NUMBER OF DEVICES(if low voltage : FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable) DESCRIPTION OF WORK: V1��- (" .S -'1{-,t CONTACT INFORMATION OWNER NAME: 01TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREETtCit $ \ � � CRY... � L ' ' x:-rT T aL...t,/ u - S7 AT � ! IPCUAO OWNER PHONE: OWNER EMAIL: �.w CONTRACTOR NAME: 0 9 CONTRACTOR ADDRESS: STREET 1 vt pp U _.. t.)Ct CIN yr �k�ti./� STATE \414.- ZIP ()-(820� 1 CONTRACTOR PHONE: L) O o CONTRACTOR EMAIL: d CSC f e C-fy)11.6D+ii-L r j✓vr CONTRACTOR LIC.#1REOUIREO):cxrthe-4'61(6-1-1d✓t CITY OF EVERETT BUSINESS LIC.#(RE?UiRED): rv}C, PRIMARY CONTACT: 0 OWNER 16kCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: �} CONTACT PHONE: L 35q D I ie CONTACT EMAIL: aelo colt/Ica-1i corn 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 of ward: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 I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only t PERMIT# �� o q7./7 E ��0 - f Owner/Authorized Agent Signature Date (Revised 9/23/2016)