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14/En- 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 vwuw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 o / j= ( As' ( S L7 1 1_ <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: D SFR-DETACHED ❑ SFR-ATTACHED D DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ cS 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: A2 I` L /3A37 . _,OC-)1A-4 l �// 1L/ y' <br /> CONTACT INFORMATION <br /> OWNER NAME: JOS 6 A-if I i_ect) / S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: /)e) <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: lz ()[/v l /�� ��//C l L C <br /> CONTRACTOR ADDRESS:/ h <br /> t STREET 7 tl 3 ) C� f S ( <br /> /1-/ S `V ( )- IS CITY STATE ZIP (9 f � <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): /0(11.5(Je4 = 7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):736? 7 <br /> PRIMARY CONTACT: 0 OWNER AtUNTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <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# <br /> / //t.0/2-C,"7-6� E 0 -- 0-3 <br /> OTS•■-e�s;w Date (Revised 9/23/2016) <br />