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04:77- 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 1 www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: -;) ) 7., C'.„.\X,.Ccs, WA\r‘—Q.
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) I. Sq:") .SF
<br /> BUILDING TYPE: 0 SFR-DETACHED „a SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: CI COMMERCIAL
<br /> USE OF BUILDING:
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<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ L\ 000, 03
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: \A,.., \\r:Q „ ', .,„s\k') 45 k, iet-, ,k -c-GJoi\\\IA:), V\01),A,k
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<br /> CONTACT INFORMATION
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<br /> OWNER NAME: k:_k ,',..— k ,„-A.Wia ' A-1V-\ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: ‘..;I REM'31' 0 Cd \ -1_,%).- ' )A- t.“(1„, Ak V)01, .L.}.AC
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<br /> OWNER PHONE: OWNER EMAIL:''.,- Z. 0(--:),"‘trt.A.0 Vi,v- (:= ''v.-4§,R. , ,,' ‘,.„Aelf),
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<br /> CONTRACTOR NAME: ? A:: '0 (:),7‘,1 \
<br /> CONTRACTOR ADDRESS: STREET k (! .(o. Lk k-f-,v- fiy
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<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
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<br /> CONTRACTOR LIC.#(REQUIRED):' 1 0 t''' : --1 ( 1 ‘\,,,,„, CITY OF EVERETT BUSINESS LIG.ii(REQuIRED)CC-31-1, k th,--,A.
<br /> PRIMARY CONTACT: DOWNER 0,,,CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 21,-E:)--- - 27-1,VA
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<br /> AGREEMENT:!hereby certify that I have read and examined this application and know the same to he true and correct All provisions of laws and ordinances govemiriehis 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 Me State Contractors Law 1827 ACW and.296201)mac.
<br /> City of Everett Official Use Only
<br /> PERMIT#
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<br /> nor/Authorized Agent Signatute `i Date (Revised 9/23/2016)
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