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• • <br /> OLT ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 -t: FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 7=7 2 —1 /✓ 6yi p ,Evo✓y/ 'je-(re � "ocq� de-es�rl' <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 2�i 0 SF r <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: c+eY <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3 2_e. '---- <br /> NUMBER OF DEVICES (if low voltage): --2.—_ <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):DESCRIPTION OF WORK: j A 5$-&tf 0,,fi.2 ora.„tf,, ,S <br /> CONTACT INFORMATION <br /> OWNER NAME: e-(,- 513j(A_Lye, r'TENANT NAME(If Commercial): 541. <br /> OWNER MAILING ADDRESS: STREET 2-Z----1 tYVAta/r <br /> CITY E V STATE 11404:1" ZIP / S 2.-C4 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: A',/-(z p -vim 4 16€i e <br /> CONTRACTOR ADDRESS: STREET 41 L 141 Itt +3 Li "'}' AA <br /> CITY hAad S V'V L2. STATE A- ZIP /8 2-"II <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: � <br /> CONTRACTOR LIC.#(REQUIRED): , ii-1-0 A)9 6115 b 1. C7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): e7 2/S <br /> PRIMARY CONTACT: , OWNER 0 CONTRACTOR 0 OTHER(Please Specify) deo� <br /> CONTACT NAME: ` CONTACT PHONE: yZs Z3 1 — I S. 3 0 1 0�-v <br /> D �' <br /> �6 r ��� ,,CONTACT EMAIL: ,) (,.,� '��r� � (�U V-1 <br /> AGREEMENT.I hereby c rtify 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 /> • >O Aa 1cb E . cg(o -- ( 4--7 <br /> Owner/Authorized Agent Signatur Date (Revised 9/23/2016) <br />