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4rerr 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 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:I 17O <br /> BUILDING AREA(if residential,new construction,remodel,or addition)t' v115 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED O DUPLEX 0 MULTI-FAMILY-#OF UNITS: PtsbMMERCIAL <br /> USE OF BUILDING:f 8.\\I fit91. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 'Sa0csl <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ,8RO <br /> ASSOCIATED BUILDING PERMIT#(if appli le): <br /> DESCRIPTION OF WORK: MI � VI <br /> \ Y 20 A f C_tVC U i4"- 4) `^ <br /> X 2 <br /> r s <br /> CONTACT INFORMATION <br /> OWNER NAME: {*QLACY..,_S TENANT NAME(If Commercial): \0(.�C\LS <br /> OWNER MAILING ADDRESS: STREET t/ `` ,�*� -- • �L S `` <br /> CITY Ck'�"�� STATE . /1V ZIPS c <br /> OWNER PHONE: // OWNER EMAIL: <br /> CONTRACTOR NAME:<C .C__ ( C` <br /> CONTRACTOR ADDRESS: sTREET7)3I,p S ,2,/_,(.>'%". 'T- <br /> (�J�f�2 <br /> cnY v YV e- STATE • ZIP-( o V J Z <br /> CONTRACTOR PHONE:Z' ) 01Z 5&z ) CONTRACTOR EMAIL: °jh( . hart v.o._iii aft Ct(.o et.•C' <br /> CONTRACTOR LIC.#(REQUIRED)a, 111 t`-JA CITY OF EVERETT BUSINESS LIC.#(REQUIRED):fl252,6S. I <br /> PRIMARY CONTACT: 0 OWNER/ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2] V <br /> Cf\\ %_t�v��(�Q,,r CONTACT EMAIL: <br /> AGREEMENT:l hereby certify that I have read and examined this application and know the same to be tare 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 tam authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> t1 <br /> City of Everett Official Use Only <br /> PERMIT# <br /> e)) E vc\n -- 'OO <br /> 4' - <br /> rized Agent Signature Date (Revised 9/23/2016) <br />