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ILECTRCAL 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE IINIFror • AT. .:
<br /> PROJECT ADDRESS: /30 q e(' - , v j
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) ZOO a SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: _ AL*
<br /> EL CTROCAL APP UCT �. (IN
<br /> r �® F0iii0r ON
<br /> CONTRACT PRICE OF WORK:$ 2�2 00 O
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 3410
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): f
<br /> DESCRIPTION OF WORK: 1 0 . rice._L oe,-2 _ 5-,e4
<br /> ly
<br /> OWNER NAME: !/ 4177/ .�!t� �,tuz,LoA5 TENANT NAME(If Commercial): S&Ls-
<br /> OWNER
<br /> ofOWNER MAILING ADDRESS: STREET )'[OO (� ),j
<br /> � C0 � [ 7
<br /> ( ?? CITY / _l��c�L -4 STATE i '" zip %24)
<br /> OWNER PHONE: q 21--- 3 - ,t0D 3 OWNER EMAIL:
<br /> CONTRACTOR NAME: /5•C
<br /> CONTRACTOR ADDRESS: STREET /Z( © CI /11/E. /471/ j4_
<br /> coy X/A STATE /2, DP gO.
<br /> CONTRACTOR PHONE: `t ZS 7Q,k, 002 CONTRACTOR EMAIL: Ck 1& Li cl.h_ Ca c�
<br /> CONTRACTOR LIC.#(REQUIRED): �.,z�t l T"`V � � (AAA be CITY OF EVERETT BUSINESS LIC #(REQUIRED)
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<br /> PRIMARY CONTACT: 0 OWNER `CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (.1 ZS'" 7 0 7 O 2-
<br /> 1M(4- L. ! - CONTACT EMAIL: Ac
<br /> AGREEMENT:T 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
<br /> type 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!
<br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> rFEE
<br /> PERMIT#
<br /> Ai//10) Lr=7
<br /> E
<br /> Own- •• orized Age t Signature Date (Revised 10/12/2015)
<br />
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