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0 • <br /> 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 <br /> SITE INFORMATION <br /> PROJECT ADDRESS: T O 11 D�� U� V LrP/ti' A (�20 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED—Z SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: g <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ZCJ <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? ❑YES ONO <br /> ASSOCIATED BUILDING PERMIT f# if applicable): <br /> DESCRIPTION OF WORK: Vutt�/�I►1 �iXISVIYI �� GiYI/1 �2J �dDo�VI YIt <br /> 2J tie-t-, 1s ) 1000or of <br /> � <br /> / CONTACT INFORMATION <br /> r -o <br /> OWNER NAME: kim'Lf Vj ll a .eaU TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j1 q_ I I �j <br /> r CITY �ey STATE w/T ZIP <br /> OWNER PHONE: 4120)ZbZ- 00F✓_"(v OWNER EMAIL: A/IA <br /> CONTRACTOR NAME: t7T t D f/t SQ E71 PCfI/(G <br /> CONTRACTOR ADDRESS: STREET (� /��Vl )(2 (fE /� <br /> UTY L a k a cfIW�� STATE V V lq ZIP-(024 <br /> CONTRACTOR PHONE: (4'Z1F)Z�01 �(O/ CONTRACTOR EMAIL: /lop ; (0 Q Cft-7(" <br /> CONTRACTOR LIC.#(REQUIRED): fe 11Vff0(4EL5q92_ QG ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):Q(_`[ <br /> PRIMARY CONTACT: NER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: G CONTACT PHONE: Lf2Gj) 2�j2— C�jGJ�(p <br /> � r�✓�/� CONTACT EMAIL: N R <br /> AGREEMENT.,/hereby certify that I have read and examined this application and know the same 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 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 /> E -7 7 <br /> 0 nerl u o zed Xqent SijdfGDate (Revised 9/2372016) <br />