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• <br /> • <br /> grr 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 pSIfTE INFORMATION <br /> PROJECT ADDRESS: /7/6 fti/ /4,1 ../X/fi <br /> BUILDING AREA(If residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: WOMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � oco, !1 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? tlYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 2N3 -u- 3 K) 0-`-pt'47 1 L A&.t , OtJ &c(Sr106 <br /> 11'1X. <br /> CONTACT INFORMATION <br /> OWNER NAME: bYkLbtn.Ahl A p ,.L,,,e, d_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I -](G, •LV, 1A4At 1.x: i`I E t 6f7 <br /> CITY gjVeMrr STATE 1.4,/". ZIP!tw/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: L Vel2aZ v 944 / Err— f4-e <br /> CONTRACTOR ADDRESS: STREET Z© 47ka4t er <br /> CITY e".\)012. 1r STATE (4'126" . ZIP J 7 LEJ( <br /> CONTRACTOR PHONE: (LfZZe, Z52_—3//Lf CONTRACTOR EMAIL: kEk'L&- (3 m kxz,aDt w <br /> CONTRACTOR LIC.#(REQUIRED):L-V $ 1Z <br /> i f3 Rol/ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):t:h`3 cs <br /> PRIMARY CONTACT: ❑OWNERoNTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ''7 CONTACT PHONE: qz.5 z 5'2_ 3/ pi <br /> CONTACT EMAIL: K„p J _1lSn-yt l,4_4(I"dowc. <br /> AGREEMENT:I hereby certify that I have reed and examined this application and know the same to be true and correct. Ali 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/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 /> 141 <br /> ,,t -7`g _1/ E Mr' 03(o <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />