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00410. , ELECTRICAL PERMIT PIPL CAT0 N <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 INFORMATION <br /> PROJECT ADDRESS: 7'7 27, Ll <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 2 (a) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR <br /> -ATTACHED 0 DUPLEX JLTI-FAMILY-#OF UNITS:_ 0 COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ IC\r)a <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): '/, f#(0 <br /> DESCRIPTION OF WORK: jt) 1iC DuR_EX f�S <br /> CONTACT INFORMATION <br /> OWNER NAME: '� �,� � t��,L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: c) t\tl \I— �j , Ill <br /> CONTRACTOR ADDRESS: STREET 6,-- s) Cr r , T <br /> CITY > A Jc_iJ ()O STATE W)- ZIP <br /> CONTRACTOR PHONE: I-{Z `) ?QS �S Sj9 (CONTRACTOR EMAIL: J <br /> CONTRACTOR LIC.#(REQUIRED): ii\r,\\ ry`�, Cjv 'J , CITY OF EVERETT BUSINESS LIC.#(REQUIRED):',)32 a(,, <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) /� <br /> CONTACT NAME: CONTACT PHONE: LIZ S 3Cjg 5 ) 5 <br /> CF--C — CONTACT EMAIL: <br /> AGREEMENT.'I 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 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 /> E CC) � \ <br /> Owner/Authorized Agen Signature Date (Revised 9/23/2016) <br />