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Feb 02 16 06:34p R& R Electrical Services 253-845-2404 p.1 <br /> RECTRI • <br /> CAL PERMIT APPLICATION <br /> OLCITY 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 INFORMATION <br /> PROJECT ADDRESS: / & -Zoe /c/- <br /> BUILDING <br /> c BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED O DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ O() <br /> NUMBER OF DEVICES 6f low voltage : ------ <br /> FIRE ALARM? ❑ YES 1364O <br /> ASSOCIATED BUILDING PERMIT# i if ap licable <br /> DESCRIPTION OF WORK: <br /> � ✓z.r <br /> CONTACT INFORMATION <br /> OWNER NAME: tel TENANT NAME(If Commercial): <br /> OWNER MAIUNG ADDRESS: s7 rice qqq <br /> T Q �( <br /> Ctrl' Y SS�. STATE 4/ <br /> z,r <br /> OWNER PHONE: 3 [�I U� OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: r,-T <br /> c ry STA7t zrP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: rn <br /> CONTRACTOR LIC.#(REQUIRED): <br /> CITY OF EVERETT BUSINESS LIC.#(,REQUIRED):, � <br /> PRIMARY CONTACT: ❑ OWNER WCONTRACTOR ❑OTHER(Please Specify) h <br /> CONfTACT NAME: n � CONTACT PHONE: �c� —�S —L 7� <br /> or CONTACT EMAIL: <br /> AGREEMENT T hereby cort4 that I have read and examined this application and know the same to be true and correct. All provisions of Jaws and ordfnancos govomin <br /> type of work will be cemptetod whatherspecifred herein erneL The granting of a permit does not prezume to give authority to violate or cartcei the provisions of any other state or <br /> local law regulating construction or tho perrorrriance of construction. That I am authorized by the ownerof this properly to perform the work for which application is made and t <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Evorett Officiai use Only <br /> FEE <br /> PERMIT:{ <br /> Owners Agent Signature Dale <br /> (Revised 1019212015) <br />