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• • <br /> OITErr 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:\ \ <br /> BUILDING AREA(if residential,hew construction remodel,or addition) a - SF z_ <br /> BUILDING TYPE: 0 SFR-DETACHED I,„SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMI -#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: 44.) _ .. eAK <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$\ noo, ec <br /> NUMBER OF DEVICES(if low voltage): tiff <br /> FIRE ALARM? 0 YES 151NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): f F, <br /> DESCRIPTION OF WORK: \1'X\f Q Q` Cam\ t , \, U-"LetV <br /> (��, CONTACT INFORMATION <br /> OWNER NAME: -2 `tip-) TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET ° LILA, � <br /> CITY ; V' 1 t9q�. F \,-.*STATE ZIP c 72.3 <br /> OWNER PHONE' �, lO '��^^,, tJ OWNER EMAIL' .- Af t'1`..t;�cltf 4 CV? t4 y -;Or) <br /> CONTRACTOR NAME: .Q,. .Q c <br /> CONTRACTOR ADDRESS: STREET\��, el• ltd\ C Y ' sRRC... <br /> T <br /> 3. -V�.J"1 STATE g\ ZIP <br /> CONTRACTOR PHONE:'\K' �-'92 } " CONTRACTOR EMAIL: CtPACA;Y1 o � � it <br /> CONTRACTOR LIC.#(REQUIRED) � l �L Z 3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C'j <br /> PRIMARY CONTACT: ❑OWNER 51..CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONEtv�.` <br /> `e .\1' V`ti CONTACT EMAIL:ckok,[ ; .Y e�ft,Li \'° <br /> AGREEMENT:1 hereby certify that t 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 /> locat taw regulating construction or the performance of construction. That f 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 WAG. <br /> City of Everett Official Use Only <br /> ' r PERMIT# <br /> I0-2,-Ic-- E 1`� <br /> horixed Agent S gnature Date (Revised 9123/2016) <br />