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ELECTRICAL PERMIT APPLICATION <br /> y CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Ill 1°1/1 pi• f'f/ cc��, <br /> BUILDING AREA(if residential,new construction,remodel,or addition) )!iJ I SF <br /> BUILDING TYPE:,SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> I rz' • <br /> NUMBER OF DEVICES(if low voltage): ilifi <br /> FIRE ALARM? 0 YES 12tN <br /> ASSOCIATED BUILDING PERMIT#(if applicable): nJIi <br /> DESCRIPTION OF WORK:. I VI V 191LPi 44l ' <br /> CONTACT INFORMATION <br /> OWNER NAME: VI <br /> 1+ivf 4140 TENANT NAME(If Commercial): 9�iir ` <br /> 041 <br /> OWNER MAILING DRESS: STREET 11 I O'I$t J. f <br /> G CITY �r STATE ZIP/i�114 <br /> OWNER PHONE: 4'1v' i f% . k 1 J OWNER EMAIL: 4 W✓� ' VAIN i41j. col <br /> CONTRACTOR NAME: F -ii✓ f-ivri ci <br /> CONTRACTOR ADDRESS: STREET I br yf fy )y. pY"i boLiob b I L t <br /> CITY 1141 (% STATE `f l4 ZIP /4111 <br /> CONTRACTOR PHONE: 11• :41 CONTRACTOR EMAIL: d avi L• col <br /> CONTRACTOR LIC.#(REQUIRED): R X. 4f' 11I r CITY OEVER "" 1`�ETT BUSINESS LIC.#(REQUIRED): 1,711141/011% <br /> , <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR MOTHER(Please Specify) 14414if,po ( (yrittizq X e1i()11 ').iii f) <br /> CONTACT NAME:pftl preicgie CONTACT PHONE: ir. 0719 .y •!pi)19 <br /> IifPOtir CONTACT EMAIL: `!I" gIy(44414rm Tih • colAGREEMENT:1 hereby certify that I have read nd examined this application and know the same be true and correcAll provisions of law and ordin noes 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 /> A . <br /> City of Everett Official Use Only <br /> pvi <br /> PERMIT# <br /> ,` r,.."0,-........." 1 J� E 160 S- V <br /> Owner/Authorized Age Signature ate (Revised 9/23/2016) <br />