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e 111 <br /> ELECTRICAL PERMIT APPLICATION <br /> _: CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa,gov/permits <br /> PROJECT SITE INFORMATIONPROJECT ADDRESS: :f r1,3 6't/I12: r <br /> BUILDING AREA(If resldenUal,new construction,remodel,or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED El DUPLEX El MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: <br /> -_ _ ELECTRICAL APPUCATUOf INFO`:MATIO1M <br /> CONTRACT PRICE OF WORK:$ ec?ri C%, :,.:...- <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES El NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> • <br /> DESCRIPTION OF WORK: / 4 c c'Iz C;%!/?/�t,."I.F /<,_ 'l�' ..,'(, c.jtl.f/1 /_if 7,1 /t ct 0 •)VI L( :4i, <br /> , <br /> CONTACT INFORMATION ' •� : , ' <br /> OWNER NAME: `� I -e:'t. I (. �r t4wtil. 1 A.St TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smear `'i'`( '- ;f'''t.'t j/, <br /> cny is ! , :Gf r (_ <br /> STATE ;%'�:. ZIP �G <br /> OUVNER PHONE: t{Z`a 1�,, ,.. '�-2z. ,. OWNER EMAIL: t:4'°6='t..t f f i r II/=� .�t E tl F: =,)0t t�� <br /> i (i et.i <br /> CONTRACTOR NAME: � `4fl.--e 1-k ^r Ir Alt <br /> CONTRACTOR ADDRESS: STREET 2120 rl�c -47r1 1 [� '>, <br /> CITY , 8TATTh (AM- ZIP 7 Lam( <br /> CONTRACTOR PHONE('Z,S`) .6 2.31!`I CONTRACTOR EMAIL: J- 'rl 1 `- r'I'''4:c.r'4. t f" (-_. j <br /> CONTRACTOR LIC.#(REQUIRED): U ,TS 2A.) CITY OF EVERETT BUSINESS LIC.#(REQUIIZED)r n,5j 5 <br /> PRIMARY CONTACT: EI OWNER ( CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: kf Z Z... i 1.14 <br /> kee tV SIh W CONTACT EMAIL: 1<'v . up -/y7 text,8S7m <br /> AGREEMENT.'I hereby certiry that I have reed and examined this application and know the same to be true and comae!. All provisions of taws and ordinances governing this typo <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 modeling construction or the performance of construction. That!em authorized by the owner of this property to perform the work far which applcatlon is made and I <br /> comply with the State Contractors Law 18,27 RCw and 298.200 WAC. <br /> City of Everett Official Use Only <br /> I / # <br /> ~' PERMIT <br /> I ,, E 101 \/ 0(0� <br /> J ; <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2018) <br /> I <br /> I <br /> I <br />