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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 FAX 425-257-8857 (E) everetteps@everettwa.govi www.everettwa.gov/permits <br /> :.:• <br /> . .. • :.... .. .. PTiSodat:.tQ'Tetoda r,°m1( °>: .< <br /> .:.. . .... . <br /> PROJECT ADDRESS: CD r l 2—C( t St—• <br /> 1= <br /> BUILDING.AREA(if residential,new construction,remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ) 'SFR-ATTACHED 0 DUPLEX Cl MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> CONTRACT PRICE OF WORK:$ 7003 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARIVI? 0 YES D NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: } Lam(`. -- Ale r,) fcg- t -h cub P. <br /> it Ct7076I <br /> _ ?'"; CONTACT INFOR HATH® <br /> OWNER NAME: S ((t)2 v- 1 ok-ke -6,4)10,004e5 TE f NT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ot$ L1�rbc'`--le"t,V'd <br /> \r\ <br /> Gm( i a T 3 tx STATE C ZIP /j J ' <br /> fi <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: "Lik 1.`c:4.1 5e t'L e S CO <br /> CONTRACTOR ADDRESS: STREET t q/3 P JLf A U. S (— <br /> cry A et.) U.5 e STATE i)A ZAPaf.x(2.S` 7- <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ( ` (� <br /> Ny` <br /> CONTRACTOR LIC,#(REQUIRED): �N�( 5, 1( -Ew TCITY OF EVERETT LI <br /> BUSINESS C.#(REQUIRED)^ 1` , <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR I�'OTHER(Please Specify) {gyp,V\V��i Ge c`c- 1 e^ -P,M) <br /> CONTACT NAME: CONTACT PHONE: CSI g)— 7 c(-J(--- f $7 3 <br /> t✓�'` tiyQvu/ _" CONTACT EMAIL: a 1. Vi-ww � �4 � lA, , (0 0.. <br /> AGREEMENT:T hereby certii that I have read and examined this application and know the same to be true andolrect All provisions of laws*d 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 I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAG. <br /> City of Everett Official Use Only <br /> FEE <br /> 2 <br /> % PERMIT# <br /> 97r7// L1 <br /> Owner/Aut. Agent Signature Date (Revised 10/12/2015) <br />