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_04:77. <br /> 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 1 www.everettwa.gov/permits <br /> PROJECT SITE.INFORMATION <br /> PROJECT ADDRESS: t . Qi <br /> 'BUILDING AREA(If residential, new;or;strust <br /> `tiodel,or addition) SF <br /> ,BUILDING TYPE: :=R-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-4 OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL-`APPLtCATIC�N INFO MflON <br /> CONTRACT PRICE OF WORK: $ 2.SO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> DESCRIPTI.ON...OF WORK: <br /> =GON?Akelt IN ORMA` ION <br /> OWNER NAME: fir, tk <br /> Z f ;: ' sort TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Les IA Owe <br /> — . a...4# t.It. STATE LiP <br /> iii. fit <br /> OWNER PHONE: 29— `''1 G.-q �y( OWNER EMAIL: <br /> CONTRACTOR NAME: C - \ d 0 { <br /> CONTRACTOR ADDRESS: STREET 4,,1 11415. O y {t, <br /> �-y,, �r�,� STATE W! - ((�� _�tt__-� 21P c)5 2o 1 <br /> CONTRACTOR PHONE: `jta l "EQ 57 dela e 0(I-w le 4- v [[ <br /> CONTRACTOR EMAIL: � yr Y t •d'�,� <br /> —`C TRAzT iR-Lic:ARF.aumtb—,: j _ ._�...__ _ <br /> CITY OF EVERE'[`T BUSINESS LIC.#REOUIRED <br /> PRIMARY CONTACT: I "`� , <br /> 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L' 5 a5q 0.` o <br /> I Wale CONTACT EMAIL: {`��'� - • ht <br /> AGREEMENT:!hereby certify that I have reed and examined this application and know the same true and correct. All provisions oflawa and ordinances governing <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 ortype <br /> local law regulating construction or the performance of construction. That lam 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 /> ,et U) q /30-18 E gOS. - 201. <br /> Owner/Authorized Agent Signature <br /> Date <br /> (Revised 9/23/2016) <br />