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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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> n PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: z, Z r (C y (11)0/7f9a)/(41,;s14 ►4 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: f 6OMMERCIAL <br /> USE OF BUILDING: • ` <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 390, <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: P/563?Aw[Z� feC"iCON,F• i'' .pp AA /tie, elk,- (7 <br /> • <br /> CON_ TA_CT INFORMATION - <br /> OWNER NAME: 6/01 (-( t?IA TENANT NAME(If�Commercial): <br /> OWNER MAILING ADDRESS: STREET Z e c,f 6 y �p +r/(,qR IL)CA) *c) <br /> CITY aVO~... STATE LI-AA . ZIP 1 Z,D I <br /> OWNER PHONE:I zc 2 967 OWNER EMAIL: <br /> CONTRACTOR NAME: lV r�1 CF�G -}�-�� ,�cj <br /> CONTRACTOR ADDRESS: STREET /BSI7o '(46i c <br /> U ITM c / STATE `J2* ZIP 91 <br /> CONTRACTOR PHONE(1/40 CONTRACTOR EMAIL: /`V AA--(r1 —'5 Cvk14A- Ltbett <br /> CONTRACTOR LIC.#(REQUIRED): E , j�` j ,) CITY OF EVERETT BUSINESS LIC.#(REQUIRED),r <br /> PRIMARY CONTACT: ❑OWNER SCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ',Hz _ 2.5. .... /(� <br /> CONTACT EMAIL: i&e 5S/V7 <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 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 tam 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 /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />