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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 www.everettwa.gov/permits <br /> 2PROJECT SITE INFORMATION <br /> 7' <br /> PROJECT ADDRESS: Q ' (J,2/>t , <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ISFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ZS cJ? - c7-13 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ZZ icy//J 7Z v r (- G 1_l/1,1)&6 <br /> CONTACT INFORMATION <br /> OWNER NAME: 0/(977/4 6vie214l,L5 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 78 0 O/7P /2('L Y I) <br /> CrrY /en.i"(/ STATE j/r.41- ZIP yU c-� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /2-- <br /> CONTRACTOR ADDRESS: STREET 76110(o 6e1../r(X /5 L.-C."0 <br /> carr STATE 7* ZIP 9i(Jzo3 <br /> CONTRACTOR PHONE: 47/2 -7 36? LECS/9 CONTRACTOR EMAIL: Q, , <br /> CONTRACTOR LIC.#(REQUIRED): �Lj� {��' /c ) CITY OF EVERETT BUSINESS LIC.#(REQUIRED /`fZ <br /> �, <br /> PRIMARY CONTACT: El OWNER 1 'CJJ <br /> ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: I CONTACT PHONE: L./Z5 327- Zf)/9 <br /> /c j/ ,�''� nto Crib /7 CONTACT EMAIL: ye-it/7WJ� '�"7( 5.-7.1',tZ). 6‘7714 <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 /> •w. Authorized Ag•nt Signature late (Revised 10/12/2015) <br />