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OLT EECTRICAL PERMIT APS _ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> V3() <br /> PROJECT SITE'INFORMATION <br /> PROJECT ADDRESS: V3()� X3(6 S 1 -jvore - I v-QA 0\ety2lb <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED jiSFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL� <br /> USE OF BUILDING: Inge +AM v <br /> U ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2,500 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES 4NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): I ,', <br /> DESCRIPTION OF WORK: K -1( Vl S m�(� ,LI `CV Ute IMin O(A-el , <br /> 0 i eflClio i fiS \n-eAN r(itx "S <br /> CONTACT INFORMATION <br /> OWNER NAME: e ppxorS TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREETOVI oi3rd St PAD <br /> 1n�Mn <br /> I A <br /> CITY <br /> ,n NVQ I & STATE �' I ' ZIP 11661-(N <br /> OWNER PHONE: lZ 301 IIW91.M OWNEREMAIL: C N(A- <br /> CONTRACTOR NAME: In I v 4 �1l C VV IVVI� s-e V I�J , I vl c . <br /> CONTRACTOR ADDRESS: STREET /p'J�15)r\ `7� ���1 1( c//�n{ <br /> CITY LV I I`-C /Ste• "� '� STATE �R p ZIP V Com',/`(J <br /> CONTRACTOR PHONE: C�ZCJ Z: °1 Il' It CONTRACTOR EMAIL: Wen SC I tr1\no USl cIQC±C' <br /> CONTRACTOR LIC.#(REQUIRED): N HOUR S VI,JZ�G CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OII (j/Ca <br /> PRIMARY CONTACT: ❑ OWNER P7 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( q'7J ) - 3203 <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 f laws arld 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 /> �, • , 09,1/1 Edi (010 02. I <br /> Owner/Abthorized n • ignature L�' Date (Revised 9/23/2016) <br /> A <br />