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ELECTRICAL PERMIT APPLICATIONIps's4r1 <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: JO(` ( I—!C � ! <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF <br /> l <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:$ d 0, c <br /> NUMBER OF DEVICES(if low voltage): -- <br /> FIRE ALARM? D YES D NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ataN -- I (2- LAA-44.r•1 At,), <br /> LI✓,) - • <br /> • <br /> • CONTACT INFORMATION . . . • • <br /> OWNER NAME: �(.t VIA. Lom,Nia. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t {1t3yrr <br /> crry �'VCr'7Z STATE GJA ZIP 2-4) <br /> OWNER PHONEz j 4o ( ''c(' c7 OWNER EMAIL: <br /> CONTRACTOR NAME: true ' y c i 4T- H�.��,^�< <1 �� 1 <br /> CONTRACTOR ADDRESS: STREET -. -I 2 o <br /> �-�'1 <br /> CIN )e-Re(.I STATE f�` ZIP Cf7� <br /> (� <br /> CONTRACTOR PHONE(C,t 1 2,52- CONTRACTOR EMAIL: keit ti1cd.5' /% <br /> CONTRACTOR LIC.#(REQUIRED): i/�� j�f ) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): c <br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1.r2s.,_ 252._ <br /> k j ( CONTACT EMAIL: ).&d &SS/Y/ Le-J .C/Uyt,( <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions oflaws 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 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 /> I c_g:Z 12- - lk E tcr,61,(2_,,yeAOwner/Authorized Agent Signature Date (Revised 9/23/2016) <br />