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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 <br /> n ' <br /> SITE INFORMATION <br /> PROJECT ADDRESS: 'GG I✓ 12 F vt I n St W V�/� W A <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �X <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES qNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: VIN YQX Urt � Y T1/tI/�� 1 F C/V 7 <br /> II ,r,, In'n CONTACT INFORMATION <br /> OWNER NAME: UnamLo_p & TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> n�nl CITY STATE ZIP <br /> OWNER PHONE: Lll1Y 1�I�� —019'?1�?� ,, (OWNER EMAIL: <br /> CONTRACTOR NAME: qvV1l (e CJ `-.li Iy(�I C lM{, <br /> CONTRACTOR ADDRESS: STREET ^ <br /> 1 ' <br /> CITY vSTATE Y'JK <br /> /� I n l ZIP /2f0b�� <br /> CONTRACTOR PHONE: C�Z�� I �J��� �j�CONTRACTOR EMAIL: G1 CGI_����hUV( Tii��"l��G <br /> CONTRACTOR LIC.#(REQUIRED): Irl I LV e5g6Z&C_ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR OTHER(Please Specify) ACT8ry _ <br /> CONTACT NAME: KOXI <br /> I CONTACT PHONE: 4 �Q7�0-?J-W2 <br /> v� CONTACT EMAIL: 16q � G rVl(�t Cj�YY� <br /> AGREEMENT:Thereby certify that I have read and examined this application and know the same to he true and correct. 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 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> * ( jot o� <br /> / PERMIT# <br /> )/,17 /Z, ( boa- F99 <br /> Owner uthorized Agent Sig ature ate (Revised 10/12/2015) <br />