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--ECTRICAL 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: j fJ p d Htj Sd q <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ L50,010 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: W5404 64 P/6) &kfA191L I,/M 5161) - %' GC4 1 dttG tWoOft G01 45. <br /> iNN G� �,� E�►3>ir� Sic �IrLcu/� �i�M �n�vllvK� SSG,✓. <br /> CONTACT INFORMATION <br /> _77OWNER NAME: jget L 7 3j7 !� e_n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE LIP <br /> OWNER PHONE: --!! �/ OWnNER EMAIL: <br /> CONTRACTOR NAME: ro llf/Y✓x si (410,f044 <br /> CONTRACTOR ADDRESS: STREET f'Z'5 jj of i ! <br /> CITYG�5 t C` STATE W ZIP 1 Von <br /> 1 Q q <br /> CONTRACTOR PHONE: ZOG,' 255- 0100 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): LO I M9 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 306 <br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAM f: CONTACT PHONE: UG Q- Z <br /> CONTACT EMAIL: 5�f <br /> 1117 Z 10015 IL4Gl <br /> AGREEMENT:T hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of/aws a 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 00 <br /> � f <br /> PERMIT# <br /> Owner/Authorized ts <br /> i ture Date (Revised 10/12/2015) <br />