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46' 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 /> P-R4)4ll CT 011: 011FxtI Ik1/ ECi" " <br /> PROJECT ADDRESS: 10004 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING:'` <br /> , s ;; ELE 1101° s i ► , 10r . t1 ;ink , tN <br /> CONTRACT PRICE OF WORK: $ 5-0 ,oa <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES <br /> ASSOCIATED BUILDING PERMIT#(I ppiicable): <br /> DFSCRIET1ON OF WORK ._.._ .� "' j-' _ .T <br /> :. AtteloR , o , <br /> OWNER NAME: zacharni ettnainifc TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: aEr /l)cZ7q 31#1 fite., c <br /> CITY ? L.�1 j ...STATE IV(� ZIP ( f! '.. <br /> OWNER PHONE: i,f✓ t fJ [ '' a OWNER EMAIL: <br /> CONTRACTOR NAME: jia • I <br /> CONTRACTOR ADDRESS: STREET 'L(15 WO adtkan <br /> CITY teelie,4 STATE ZIP q5 2c2 I <br /> CONTRACTOR PHONE: l"I 5 1 Q CONTRACTOR EMAIL: d€. 2'e a Cmhea+n r YV1 <br /> LUN I RACTOR t 1C.#(REoutRE;D}: . -- <br /> �� * t I C����� [CITY OF EVERETT BUSINESS LIC.#(REQUIREDj: <br /> PRIMARY CONTACT: ❑OWNER 16,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: `` CONTACT PHONE: � lJ 36ei o <br /> 1 Wale CONTACT EMAIL: d. . !1s ' v`'tai") •G0rn <br /> AGPtEEMENT:f hereby certify that I have read and examined this application and knew the same to be true end correct. All provisions of laws and ordinances governing lies type <br /> of work will be completed whether specified herein or not. The granting al a permit does not presume to give authority to violate or Cancer the provisions of any other state or <br /> twat raw regulating construction or the performance of construction. That I am authorized by the owner of tiffs property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 786.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ptebb_4- 61.1.Leiti 5 ea � • IF E 6 ,0(0-0(0 (0 <br /> OwnerfAuth9riz�ed Agent Signature Dale <br /> (Revised 9/23/2016) <br />