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(-) <br /> ELECTRICAL PERMIT APPLICATION <br /> I �, CITY OF EVERETT PERMIT SERVICES paL,.. <br /> I l) <br /> th <br /> 3200 CEDAR STREET, EVERETT, WA 98201 - <br /> (P)425-257-8810 ( FAX 425-257-8857 ( (E)everetteps@everettwagov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:c. I L (, t <br /> BUILDING AREA(if residential,new construction,remodel,or addition)Z',Sdkov }C A SF <br /> BUILDING TYPE: ❑ttSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS:__ 0 COMMERCIAL <br /> USE OF BUILDING:.f'}c . <br /> ��'��' """""" ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ S <br /> NUMBER OF DEVICES (if low voltage): . <br /> FIRE ALARM? 0 YES '®NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: t,- r,C ts <br /> • <br /> CONTACT INFORMATION <br /> ) <br /> OWNER NAME:awe kLi �l(1 k\( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET,:(.) /Q v&/(1z0 <br /> ter' rf_t,�. STATE \ +(`/ <br /> �j�yCIN � t � j �i}� ZIP 1 7j �,, <br /> OWNER PHONE:((CIE;'3(1q , � 07 OWNER EMAIL: <br /> CONTRACTOR NAME: (iU ((,L4 (+4 r <br /> CONTRACTOR ADDRESS: sTRCET ( _CS 4 c ' - J <br /> jay �,.y�, t 9 <br /> CITY/ �6V1 I CJ y r 7 15� �;�y � STATE �: �{. ZIP <br /> CONTRACTOR PHONE:3(QU( / ' r�0O CONTRACTOR EMAIL:S-L LA�' ' GlC rr A&SG <br /> CONTRACTOR LIC.#(REQUIRED):(� + �} I gpc-1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5 75 <br /> PRIMARY CONTACT: 0 OWNER WONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: { CONTACT PHONE: ?C ()Cf( f ' ) <br /> ir6? c) <br /> ` 4 l( (in, CONTACT EMAIL: )t Q.�t )t�1 DLL-4 C(2 t'�') Cbk_G 4, -6r <br /> AGREE N 'T:T hereby certify that t have read and examined this application and know the same to be true and coned 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 298.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 00 <br /> \ L, <br /> t PERMIT# <br /> 0 \\NU.' ) () <br /> /\\ 6111;—( E I <br /> ner/Authorized gent Signature Date <br /> (Revised 10%12/2615) <br />