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• • . <br /> 477- 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:(j7 j 1 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /,5(7 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ri� (3) O J1(VI (104' (-r 61 <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 ��,�/� j S TENANT NAME(If Commercial): t Li) <br /> OWNER MAILING ADDRESS:9"sTREEr .l cr C Q 1 43A Jk STATE i zip >7®(G7 <br /> OWNER PHONE: OWNER EMAIL: �' <br /> CONTRACTOR NAME: i C n Vo` t Yl� <br /> CONTRACTOR ADDRESSi 3tcl STREET f !__ C tW qr\f 'X L.C) IP a <br /> cry `�'tt_ STATE 1- ZIP `J evn, <br /> ' <br /> CONTRACTOR PHONE:3 lo(>-107/ -- ) 73 CONTRACTOR EMAIL: L i !`P CZ '11-42-- j�9 n D/ .62351) <br /> CONTRACTOR LIC.#(REQUIRED): 5/6.M I X—(-1,40 0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):bS 0(P <br /> PRIMARY CONTACT: 0 OWNER I "CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: .2)(ev/� - ( _ i3(f <br /> CONTACT EMAIL: Lb r L� r� S`as,n pr s (t_t1) ) <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 lavd and dinances 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 /> _ _ E1ct0(0-Ie'4 <br /> G ziwner/Author zeed Agent Signa ure Date <br /> g g (Revised 9/23/2016) <br />