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ELECTRICAL PERMIT .APPLICATION <br /> _4 CITY OF EVERETT PERMIT SERVICES <br /> - . 7 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> PROJECT SITE IIG FOR iliATIOG\' <br /> PROJECT ADDRESS: O (,3 VIS <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: _'` <br /> ELECTRICAL APPLRCATIIM F S RI 1A`ll IO!t! <br /> CONTRACT PRICE OF WORK: $ ) Ie .( <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? , YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ( 'LL) po r\•v,\r&e L\SS_�vM t Pu ;it <br /> t <br /> cif �X�i C'4Vi v ` . � "11-C7 C C9✓trvzj <br /> ae. Ito ZLWV 2COa v P <br /> CONTACT INFORMATION. .. <br /> OWNER NAME: �)✓e.le S6(1.0) TENANT NAME(If Commercial): f Ick 1,(211 e l two. <br /> OWNER MAILING ADDRESS:, STREET `-cCf• <br /> \-- CITY STATE (A. <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: e <br /> CONTRACTOR ADDRESS: STREET t--1 V' L3 ((/\ /4„_.),/,---� �( <br /> CfY STATEr �/LJ ZIP �g l <br /> CONTRACTOR PHONE: Li.)S`(S7(o--7 y Z t CONTRACTOR EMAIL: c4 () Cc- e 1?'L.c ✓� <br /> CONTRACTOR LIC #(REQUIRED): r2 \ems R I-L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): S 3 (n <br /> PRIMARY CONTACT: 0 OWNER *ON'TRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (4 .o• <br /> �( • • . 1 . <br /> C(,` = GQ� CONTACT EMAIL �J� tz6 ��c P. `!p( ( i ✓�'l <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 l 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 /> FEE <br /> PERMIT# <br /> WZO1 j <br /> Own- /Authoriz'.Agent Signature Date (Revised 10/12/2015) <br />