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0 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 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ITE INFORMATION <br /> //��///� <br /> PROJECT ADDRESS: l t 01 <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? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: t-E C�G�e,,,, OAtA f <br /> ` �r <br /> LA <br /> CONTACT INFORMATION <br /> OWNER NAME: A v V 1, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET `01 k q �ULk -eX1CR-,�j It- <br /> �-}' <br /> CITY L��Cv.�(/ STATE L"-� ZIP <br /> OWNER PHONE: " '315 713 OWNER EMAIL: <br /> CONTRACTOR NAME: �CNID eYL_ L <br /> CONTRACTORADDRESS: STREET c 0" &II <br /> CITY O'vo STATE �, 1 ZIP q _ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> L �� t kC�-� t✓�1.0 <br /> CONTRACTOR LIC.#(REQUIRED): �ivo E�X104, � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER .✓2. ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Y�f�(p q— e q'?73 <br /> CCgI/t �F�drCE`pV CONTACT EMAIL: C C Z C K eV�( BG (L - L dam_ <br /> AGREEMENT:1 hereby certify that 1 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 /> Owner/Authorized AgentSuture Date (Revised 9/23/2016) <br />