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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 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: °I52z/ /S7L A-ve SE r ('Ver-eiv4 98200 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED PR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING:51i/1,91e —a vi1 1 (j C 1 vI <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ I G1DC) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ,L410 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): arc n <br /> DESCRIPTION OF WORK: 220 amp awl tui l <br /> C` ONTACT INFORMATION <br /> OWNER NAME: MOn1\ S l/Y vw\n TENANT NAME(If C <br /> ommercial): <br /> OWNER MAILING ADDRESS: STREET VI ' Ve <br /> CITY EVy /LItSTATE w <br /> / 7iP V[/1� <br /> c6�/�/2•///70i?) <br /> OWNER PHONE: 20(0 056/—(-(20 -67, OWNER EMAIL: V n, <br /> CONTRACTOR NAME: l utc-hico Str✓ (cec [n// <br /> CONTRACTOR ADDRESS: STREET DaSE <br /> CITY / j -he /e Js STATE PI ZIP <br /> CONTRACTOR PHONE:04 2512361-Q\ \2 CONTRACTOR EMAIL: \\A COICnInVS'SnefC IC . C /(( <br /> �J7 <br /> CONTRACTOR LIC.#(REQUIRED): /`V I f 0 4e q 2QG CITY OF EVERETT BUSINESS LIC.#(REQUIRED):01441 eca <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /� CONTACT PHONE(2/2 ) O 'm�ZO� �p <br /> �v�C� CONTACT EMAIL: lS�l�1j�PP/v� C. 011 IG{ i/.W{1--) <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 ancTordinances 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 /> 41111" City of Everett Official Use Only <br /> v/(0 PERMIT# <br /> E <br /> Owner/A.•hori ed Agent Sig . •re Date (Revised 9/23/2016) <br />