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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 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT FTlld <br /> fe <br /> PROJECT ADDRES <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED )(SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: • <br /> : <br /> CONTRACT PRICE OF WORK:$ 70e° <br /> NUMBER OF DEVICES(if low voltage):, <br /> FIRE ALARM? DYES 0 NO <br /> ASSOCIATED BUILDING PERMIT/Of applicable): <br /> DESCRIPTION OF WORK: 11 A ) <br /> r.A.i 3 <br /> r # C rio — 0 ( L) <br /> • CONTACT NFORMATION ' " • " :"' '-* <br /> OWNER NAME: S i*t oev- 1 ckke A,013A wie5 t'fhlkNT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr 11-5 •5.• e.uo,rd <br /> ow Tor O\oL,V,-(3N— STA 7E A ZIP <br /> OWNER PHONE: gi - spd— - Cs-60 OWNER EMAIL: <br /> „ <br /> CONTRACTOR NAME: 'T_vt,rvis A e ' `c $e r u t\C.e S C <br /> CONTRACTOR ADDRESS: STREET 13 7iti A oe. S <br /> cnY A] -e.k) Lex." 4-1e STATE tAil A ZIP et g 6S"9L <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIG.#(REQU1RED): ,NIF-5cti'D...,r4— CITY OF EVERETT BUSINESS LIC.#(REQU1RED): L't H ( <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR OTHER(Please Specify) yvj Gck.-1II <br /> CONTACT NAME: CONTACT PHONE: ( ' 7 cf-(f- 3 <br /> G-eA4J1P4v <br /> CONTACTEMAIL: t) qp ciat tea_ fo OU'I ( <br /> AGREEMENT:Thereby Gerd that I have read and examined this application and know the same to be true andtafrect Al I provisions of laws 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/am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 2100 <br /> AO/ PERMIT# <br /> Aoti,dr- 9( ta <br /> HE 0 Zoct <br /> Owner/Aut,4,4°1e71 Agent Signature Date (Revised 10/12/2015) <br />