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4E77' ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: (41 3 5 -m S t <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE; SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ c .cc' <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#of applicable): <br /> DESCRIPTION OF WORK; )AS feat— <br /> CONTACT INFORMATION <br /> OWNER NAME: 41(I61:1 5c.hata.ell TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET cti 3 ( <br /> Q� STATE 14) Vo <br /> S <br /> OWNER PHONE:L/ X72 43505OWNER EMAIL: <br /> CONTRACTOR NAME: C r 1 IN2-col0 9 yy '' <br /> CONTRACTOR ADDRESS: STREET 4J 11A1 OO.5JtQ <br /> CITYIT+ ke, ( STATE A ZIP qt 20 <br /> CONTRACTOR PHONE: 1-1Z—p)5"I Q b{ CONTRACTOR EMAIL: d€bI e 0i/rhea-ling , <br /> CONTRACTOR LIC.#(REOUIRE7):CXYt e Cl{I�'1r 1 ��( rl CITY OF EVERETT BUSINESS LIC.#(REOU€F ED): LOOC142) <br /> PRIMARY CONTACT: ❑ OWNER {,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: t CONTACT PHONE: -- 3 359 <br /> VOcioie. CONTACT EMAIL: <br /> dP.lobi hcati r-9 .cone) <br /> AGREEMENT:1 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 slate 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 /> S � <br /> `_ >� -2�.l E "k:p( - 2c ( <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />