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0 9 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT S�ItT/EJ INFORMATION <br /> PROJECT ADDRESS: O j c� �(/C✓C / r / v <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: $ 17 it& <br /> NUMBER OF DEVICES (if low voltage): /.7 <br /> FIRE ALARM? j'YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): / <br /> DESCRIPTION OF WORK: '04 �C l rrt <br /> (�f <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY Sl ATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Fc eCOF MM ! --s <br /> CONTRACTOR ADDRESS: STREET �o o- r• 9 <br /> CIN !/�L Lv� STATE ZIP <br /> CONTRACTOR PHONE: ZO�o'S7�/S y�o CONTRACTOR EMAIL: /`-IA O As 4 A - _ <br /> CONTRACTOR LIC.#(REQUIRED): ���Sd D CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER I)MONTRACTOR ❑ OTHER(Please Specify) <br /> CONTA NAME: CONTACT PHONE: �D - 391' o <br /> CONTACT EMAIL: M'/ %. q. '0f, <br /> AGREEMENT:T 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 <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 of <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4 ��15 I <br /> PERMIT# <br /> 57 <br /> E � � , j �� _ <br /> Owner/Authorized A ent Signature Date (Revised 10/12/2015) <br />