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110 • <br /> 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 (E) everetteps@everettwa.gov J vwvw.everettwa.gov/permits <br /> 1PP OJECT SITE INFOI*MATION <br /> PROJECT ADDRESS: 2 2:771 Ilk✓,fr-/ ✓ &v'J /- /1 L / rale7. 1 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: Its SesFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING:f9/-✓ /.jm/ /.2-, <br /> ELECTRICAL APPUCATI'e N INFORMATION <br /> CONTRACT PRICE OF WORK: $ j,.� �r„//�, w�j�(rL L c7c 43I i_"e(� <br /> NUMBER OF DEVICES(if low voltage): c01110--cq5 <br /> FIRE ALARM? ❑YES ©NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):Fve/r _ 1.,,e-2Lo <br /> DESCRIPTION OF WORK: / iJ G, Wr'f /0 Sc79 l // '-�V _/1"cLt } 1, ,`,iv <br /> the//`,�/� max'/�-.�✓ //jh Ji/�-'S Cc 41Gr�z �/r, �t/dcr. t�- <br /> V2i fay- L,k�irr�fi✓ /..)211G G/ - t f-04!7 / k a L/ <br /> - CONTACT INFORMATION. <br /> OWNER NAME)-: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 22�/ &aV,>i' -) _/ <br /> CITY �j/�'"� STATE IA/ i� ZIP lq ) <br /> OWNER PHONE:4,/-z.5 ` w F-''`_J / OWNER EMAIL: �sj3� 5fie14,67Atin & it70,/�G <br /> CONTRACTOR NAME: 0.0141Q4P— <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR L1C.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT T 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 <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 I 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 /> PERMIT# <br /> y/ <br /> er/Authorized Agent Signature Da e (Revised 10/12/2015) <br />