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477 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 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4150 w(=� - ►2-- <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: t -SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> EtEtTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ZOO °° <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ?NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 9h/2Te 61- pp/ n/ <br /> CONTACT INFORMATION <br /> OWNER NAME: VUR TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1X' 4 i--froc, /� ;;P;--19 <br /> ^ <br /> CITY k-Y &jt 7T STATE 1."-/ , 1 ZIP �J2 o <br /> OWNEF'PHONE: 1-(1,3-:3 Y -- 3(14/ OWNER EMAIL: <br /> CONTRACTOR NAME: L/,11,0 <br /> CONTRACTOR ADDRESS: STREET Ott (fr I.J,L <br /> CITY C ' VVI()P./IJ STATE V v 1 ZIP <br /> I <br /> CONTRACTOR PHONE: „AKj `,3-7pCONTRACTOR EMAIL: //t/l( vt C/ -[ • - —_ ?. <br /> CONTRACTOR LIC.#(REQUIRED): (-//VO[ �.C�I uo c.2j CITY OF EVERETT BUSINESS LIC.#(f UIRED):() • <br /> PRIMARY CONTACT: ❑OWNER ICONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: 4--(9-57-L67._ C�q 7 <br /> /14/1(6'V/^��E�h�" CONTACT EMAIL: <br /> � rl1/t,1�-G„-r tic 6-t <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# <br /> ar-• / //13-77t E 110 ( 2 - RLI <br /> Owner/Authorized Agent Sig .ture Date (Revised 9/23/2016) <br />