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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> `44C0'° 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@overettwa.gov f ww.meverettwa.gov/permIts <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: e fLatit tt" A\ <br /> BUILDING AREA(if residential,now construction,remodel,or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED El DUPLEX El MULTI-FAMILY-#OF UNITS: Ei COMMERCIAL <br /> USE OF BUILDING: ( -01M ev'IC. \ 1t & - • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? DYES El NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: P0.4.4 ; ')(„ 1.;,\C“: Y-<'* ' )7(e',7:0 r f-"P <br /> . . <br /> CONTACT INFORMATION • <br /> . . <br /> OWNER NAME: AjCI,11,4 ti^'0 1) 7' TENANT NAME(If Commercial): <br /> „„ <br /> OWNER MAILING ADDRESS: smoEr I 17, 14(-1,+ °(7 4vt, <br /> crry t)* STATE C L'4 ZIP 2.e,7cf <br /> OWNER PHONE: f-tl .; 2I L > OWNER EMAIL: <br /> CONTRACTOR NAME: Atre Her lee A <br /> CONTRACTOR ADDRESS: STREET *Z1 0 rOdt-C-C. <br /> C/TY a)C(261- STATE 1.../..44- ZIP qta-t <br /> CONTRACTOR PHONE(9g6) z,c2- i CONTRACTOR EMAIL: _ <br /> CONTRACTOR LIC:RREQUIRED): OV472.8 RA) CITY OF EVERETT BUSINESS LIC.#REQuIRET!•06:7155 <br /> PRIMARY CONTACT: DOWNER DICONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t.fn,.. z5-2_- ?ff4 <br /> SX- -0- CONTACT EMAIL: .68 tA....<g? <br /> AGREEMENT:I hereby certify that I have mad end examined this application end know the same to be true and correct. All provisions of laws and ordinances govemlng 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 Jaw regulating construction or the performance of construction. That!am authorized by the owner of this property to perform the work for which application Is made and <br /> comply with the State Contractors Law 18.27 ROW and 298.200 WAC. <br /> City of Everett Official Use Only <br /> / // PERMIT# <br /> /-/ <br /> 40- E \ <br /> Owner/Autihorized Agent Signature Date (Revised 9/23/2016) <br />