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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: '3O clin 6V�aek( f/4 82b-s> <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: <br /> NUMBER OF DEVICES�(if low voltage): <br /> FIRE ALARM? L1'YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 6101 17 4U7t-( /0360-&t' teJW 0 10eel lOC6611 <br /> / IT ayld i-�G <br /> / CONTACT INFORMATION <br /> OWNER NAME: Part Ce/CI/7e% ,9Wa- ,e_1W TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETGZ <br /> CITY {.ter CA STATE w ZIP <br /> OWNER PHONE: 4 25 -/ Og - a OWNER EMAIL: t j,Sl1 �- O,s't �/ to coln <br /> CONTRACTOR NAME: AGl W1 e <br /> CONTRACTOR ADDRESS: STREET) •3? /S,�V -krIC M10i7 Jt. <br /> / GITY Sea-1-61e. STATE rJ ZIP <br /> CONTRACTOR PHONE: 20c 1-735-6/00 CONTRACTOR EMAIL: �C�. C Ct ll �lPe GrLh`G �C� <br /> CONTRACTOR LIC.#(REQUIRED): ,4t CE I CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0, 10J <br /> PRIMARY CONTACT: ❑OWNER 0,60NTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> jefe//� Ci /I CONTACT EMAIL: <br /> t• ZO/l/ <br /> AGREEMENT.I hereby certify that I have read and examined this application and know the sam 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 perforin 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 /> -E I C l b- �OZ <br /> Owner/Authorized A ent Signature ate (Revised 9/23/2016) (� <br /> 7j <br />