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4577 ELECTRICAL PERMIT APPLICATION <br /> 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: �( S E _ V C ?t) M /4-U <br /> y S !E- 30 I <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 7(537-) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: %( vi</(C. .Q k P 65")'1 <br /> ADD D 7"&7 6 k / p 0-24 if "Le 9s 1�� le9Cee c-t c.� <br /> 1- CONTACT INFORMATION <br /> OWNER NAME: P I'-LC' E Co P - Pt. f v/t' :13ANT NAME(If Commercial): 'Fa Rol s7-4 FC "n/6 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 43)41164-iv L/ CT)/ C 12 c <br /> CONTRACTOR ADDRESS: STREET 0-7; g^�, {2-, 9 P1 PJ- w (J�t� / <br /> CITY GID A“)-APO s STATE W ZIP ? O v/Z <br /> CONTRACTOR PHONE:,CC G t , 'e <br /> CONTRACTOR EMAIL:TA #-S LZ z/6'Q� tJ L66)11 e -Cc9°/-1 <br /> CONTRACTOR LIC.#(REQUIRED): LSC a-C Z [J 2-32 rV o CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O 5'1'7 9(u <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'O6 ./ G L( <br /> 7 CONTACT EMAIL: Typ-C 5 6 j2(�LdC,O�r l;'i Cc-)2 tC - w a r <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 /> PERMIT# <br /> -) EIBI <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />