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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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4?fi YA4 J 62,,,,- <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2`606 <br /> NUMBER OF DEVICES(if low voltage): 1 hs`7_,.S -_s-r-r- <br /> FIRE ALARM? Q YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: _ •Vd , Y., 4 ' , . 0 ZGtiJ N:it) '. t=om <br /> 1- :t .p Ta r 4r7 <br /> • <br /> • <br /> • <br /> CONTACT INFORMATION ' • <br /> OWNER NAME: M-t,L,,w( I lfZ6Zet.,• TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '2.. ��Z)) 2L c. a �� <br /> q <br /> CITY (�art��l - <br /> STATE ZIP t 2-0) <br /> OWNER PHONE: ) 760 - 61326 OWNER EMAIL: AYiet <br /> CONTRACTOR NAME: eV --�fl.�c_4U4-'-6- 1.4exlr 'T ,1-(1 <br /> CONTRACTOR ADDRESS: STREET 2120 WG <br /> crry ajeReir STATE WA- ZIP?8-' ( <br /> CONTRACTOR PHONE(JZ) -- 3//(4- CONTRACTOR EMAIL: 14?vt 6 f Wet<C t. i <br /> I <br /> CONTRACTOR LIC,#(REQUIRED): p�� �,5c 2O r ry CITY OF EVERETT BUSINESS LIC:#(REQUIRED):66-76(55- <br /> PRIMARY CONTACT: ❑OWNER ILICONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: tFLE2.5-2,- //t. <br /> ,�e;k) �r�L-0 CONTACT EMAIL: - .6:41.1 <br /> @��s�r� tJ��,C <br /> AGREEMENT::I hereby certify that I have read and examined this application and know the same to be true and comet. 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 state or <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 end 296.200 WAC. <br /> City of Everett Official Use Only <br /> , 9 <br /> PERMIT# <br /> .-.----''C')-- <br /> " V q i1 E Q q 09 - 015- <br /> Owner/Authorize Agent Signature Date (Revised 9/23/2016) <br /> 1 <br />