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4E77 ELECTRICAL PERMIT APPLICATION
<br /> CITY 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
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<br /> PROJECT SITE INFORMATION
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<br /> PROJECT ADDRESS: i l I W 'ASM-I N. C-1 '...Z,• (A) /4`(
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF
<br /> BUILDING TYPE: ❑ SFR DETACHED 0 SFR-ATTACHED 0 DUPLEX LTI-FAMILY-#OF UNITS:_ 0 COMMERCIAL
<br /> USE OF BUILDING: al P,A544--, v-yl6--
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK: $ i ;"
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES oNO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> DESCRIPTION OF WORK: ..14.2,-.ii-14-0 („.(yc4T„A C_,,,2.4-...,.. _i s (�.�;2-r /`^-T- _l r;�•;,---,A-..4 k..f(4)
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<br /> CONTACT INFORMATION
<br /> OWNER NAME: i'r1G e tom. ,;..+ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: fZ ,.jS s OWNER EMAIL: ",1 S'‘'/77`(r�w" �q;t 6,et _.L0
<br /> CONTRACTOR NAME: I~1CA't#33 Cj r '---t:7 '1.24:•-•4----42--,c, Wil'._ .
<br /> CONTRACTOR ADDRESS: STREET 0\\r��qq�,7,: C s ci
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<br /> CITY f--,l..v�{,):t�1/7)(>-- �+ STATE Vc, A ZIP V`57)4-
<br /> CONTRACTOR PHONE. , 7 , > b2, CONTRACTOR EMAIL:,,t.$,4 in fi tu`; , .a:'-074±-2-4- 'VAC -(;D "
<br /> CONTRACTOR LIC.#(REQUIRED):PIA tW*;c j C., 5-04- CITY OF EVERETT BUSINESS LIC.#(REQUIRED)6e4'?'!
<br /> PRIMARY CONTACT: 0 OWNER ,. ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT A.,..,,..,Fr ('A„,q,-`/,„, CONTACT PHONE: '2,0L„r._ q ...,i Cf;tc
<br /> CONTACT EMAIL:
<br /> AGREEMENT:I 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 type
<br /> 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 /> PERMIT#
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<br /> rized Agent Signature D to (Revised 9/23/2016)
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