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4477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES (9-76c' '-"l ?7 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 - .D-6 --1& <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION • <br /> PROJECT ADDRESS: I 422 2 t1Ld Ave SE <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED igSFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ WOO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ®NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ',, " ' <br /> DESCRIPTION OF WORK: VepI CICe ZOO p pa►L ) ►nsf c I-1-0 aYYip rainy e I(U,(,l-t- <br /> 1 CONTACT INFORMATION <br /> OWNER NAME: M(.y OD TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: y',, ^,, ' OWNER EMAIL: <br /> CONTRACTOR NAME: 1 � 1J Q Fla-trial �J-evVI VLS i Inc,• <br /> CONTRACTOR ADDRESS: STREETTtIO 1 lith Dr Te <br /> CICITY "N Lot/D tgA1 nSTATE Vi& y�,, ZIP <br /> CONTRACTOR PHONE: (141 )23°1-01,0(3 CONTRACTOR EMAIL: l A C a Sly/I n h61,�Se tiec4 4 (C.e <br /> CONTRACTOR LIC.#(REQUIRED): i n h0tt 05 oiS 2 a& CITY OF EVERETT BUSINESS LIC.#(REQUIRED):NO I W <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 'OTHER(Please Specify) off U 1� V <br /> cirA <br /> CONTACT NAME: t`J�y CONTACT PHONE: (LI'2 ) 1�e 0 - 31,67 ) <br /> CONTACT EMAIL: 1ireS CC f� \Gk ,. MAA <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true aid correct. All p isions bfilaws and ordinances governing this <br /> type 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 1 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 /> FEE <br /> 4 1 0 0 ,e-Q- <br /> PERMIT# <br /> �� �� E I (,02- 1 <br /> Ow (r/Aut rized Agent Signatur-� V Date VI. (Revised 10/12/2015) <br />