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41ETT 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 SITE INFORMATION <br /> PROJECT ADDRESS: 35 2 i Lom bare / %1\f <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: \SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDIN5: �` f3 02/xita_1— <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 14 000,UUJ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(f applicable): <br /> DESCRIPTION OF WORK: (2_OO(X\ f T . <br /> CONTACT INFORMATION <br /> OWNER NAME: L t a t A 1�-)a r% Au, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3�J 5 L~ rXt r10/ ' <br /> J C CITY /ve r� - ! <br /> STATE V A ZIP '6Z o I <br /> �, <br /> OWNER PHONE: 12 -953 - O(vQ 2 OWNER EMAIL: (..3 � <br /> ea., <br /> OC 6-S . I ) yowl- cow? <br /> CONTRACTOR NAME: (SCQ roLoyl «C'1`'rl C) (or <br /> CONTRACTOR ADDRESS: STREET . f 3 ` Lj( o ck c C12/67 <br /> CITY iVe,V'-6,- l STATE V V A ZIP I q720 1 <br /> CONTRACTOR PHONE: )..a0 clo5 3(0 ' O CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): SEATO&C (c,4 g .6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):5 %R I C, <br /> PRIMARY CONTACT: 0 OWNER /k CONTRACTOR 0 OTHER(Please Specify) <br /> CON ACT NAME: ( CONTACT PHONE: <br /> (;C\ / a Q'(.) CONTACT EMAIL: @ V APSea—klAYNCI-6Ctr-i.0• C 0 <br /> AGREEMENT.I her:6i certify that I have read and examined this application and know the same to be true an correct. All provisions of laws and ordinances governing <br /> of work will be comp eted 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 /> PERMIT# <br /> .,/ ' / 6-0 1611 cb E k?)05--' ) ))-)( <br /> Opy6ner/Auth zed Agent Signature Date (Revised 9/23/2016) <br /> 1 <br />