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�,,,+,. - 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 www.everettwa.gov/permits <br /> PROJECT SIT ,INFO aMATION <br /> PROJECT ADDRESS:5 302 4 A {N <br /> BUILDING AREA(if residential,new construction,remodel,or edditton) SP <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS; 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL.`APPLICATIO1'41 MFOR MAtIOR' <br /> CONTRACT PRICE OF WORK: $_- � coo <br /> NUMBER OF DEVICES{if low voltage): <br /> FIRE ALARM? ❑YES <br /> O <br /> ASSOCIATED BUILDING PERMIT#(Ifa plicable)_ <br /> D.ESCRIPTION_OFIVO.RK,_ 11(6+41[ kkle.ChrialI� ' <br /> palk2e4e-ifeetif waiter Ivet*K- <br /> Ei <br /> .I <br /> - ,coffrAlot INE3EII1 OE'N <br /> OWNER NAME: f/CA,r '1}11 5 TENANT NAME(If Commeralal): <br /> OWNER MAILING ADDRESS: STREET S-�' 3 2 � 3 d Ave. j a ) <br /> Cf Ty �.._pe ti� tit 1 t/t.:.2tt-- ' '2C., <br /> � STATE 7i€' <br /> OWNER PHONE: 412 2-20 <br /> - SL-10 (OWNER EMAIL: <br /> CONTRACTOR NAME: ryl <br /> CONTRACTOR ADDRESS: STREET J L WOc <br /> r <br /> a ,P� ^ry <br /> CIN • STATE ZIP Ci20 I <br /> CONTRACTOR PHONE: � � *„� j 011149 CONTRACTOR EMAIL: ! / #' <br /> Viti <br /> CONTRACTDF;-L�IC:#(RE�tUCFzEi�};G��'),�: _ <br /> t7`l d CITY OF EVERETT BUSINESS LIC #REQUiREt3 GF <br /> PRIMARY CONTACT: ❑OWNER p.,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: aS Cf D <br /> Pe„thie <br /> CONTACT EMAIL: deb h , -cotes <br /> AGREEMENT:I hereby certify that I have mad and examined this application and know the same to be true end correct. All pmvisions 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(he performance of construction. That 1 am authorized by the owner of(his property to perform the work for which application is made and I <br /> comply with the Elate Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> CULVUS 1/21/N E nCi-(ure Owner/Authorized Agent Slgnat <br /> Date <br /> (Revised 9/23/2016) <br />