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0 <br /> ELECTRICAL PERMIT APPLICATION <br /> 4e7r 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 INFORMATION <br /> PROJECT ADDRESS: i C A i7-V-42-if <br /> _V-Qi 6; Yl U_) CL--BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: O SFR-DETACHED O SFR-ATTACHED O DUPLEX O MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: CX J o' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? o YES o NO -T( 2� <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> ( _ <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> --�' V& 9I4A?LNAME(If C0----"-"- <br /> --7 <br /> ommecial - c �� <br /> OWNER NAME: / ti�/O <br /> OWNER MAILING ADDRESS: STREEA <br /> CITY 7-v e STATE w ` ZIP <br /> OWNER PHONE: `OWNER EMAIL: <br /> CONTRACTOR NAME: < l!( � LL _ <br /> CONTRACTOR ADDRESS: STREET U � <br /> CITY , r l u. STATE I1 J ZIP <br /> CONTRACTOR PHONE: S 7. _/ ONTRACTOR EMAIL: <� ��' s r I J r�PQ:C ' <br /> CONTRACTOR LIC.#(REQUIRED): ' it L 3S D CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (0 <br /> PRIMARY CONTACT: O OWNER O CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: -,)-!53 R 0e1_&S7 <br /> I ('GL(s t' <br /> L , , CONTACT EMAIL: J�r7`�/ (C'( R" W1 Cdr [ <br /> AGREEMENT:I 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (Revised 923/2016) <br /> Owner/Authorized Agent Signat Date <br /> /rrrVVV <br />