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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 1 (E) everetteps@everettwa.gov I wvvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5 <br /> BUILDING AREA(if residential, new construction, remodel,or additi(jn) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: CGP:iMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2-1:30 • DO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicauey <br /> DESCRIPTION OF WORK; 55 KQ oU v�D <br /> �^ CONTACT INFORMATION <br /> OWNER NAME: �- enp C"]Q i I gyAe_ TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRE sTREET -j�jZ.Lj LJIJ <br /> ZIP K, 1 <br /> OWNER PHONE: tfa,,j c�14 ?Jj-(, OWNER EMAIL; <br /> CONTRACTOR NAME: (�J_Yj KQ0_1�()C{ <br /> CONTRACTOR ADDRESS: STREET <br /> 1 I; Wo adt _ <br /> CITY t j�P�� _ STATE WA ZIP q? ��I <br /> CONTRACTOR PHONE: 1�p�5 a5q 093-6 C' �CON�TRACTO�REMAIL: C CQyytCONTRACTOR LIC.;/iREQUIRED :CYYlheY1h��� TY OF EVERETT BUSINESS LIC,tx,REVUIF?EU): l lf/� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ln(n CONTACT PHONE: I�5 359 <br /> CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct, Ali 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 glve authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That/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 /> 4_ -T--' -_- <br /> Owner/Authorized Agent SignZatur-c Dale (Revised 9/23/2016) <br />