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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 INFORMATION <br /> PROJECT ADDRESS: ;7 Z-,7 Oa �S �� 'le2_0 I <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR/DETACHED FR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 104�T(, <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 'ZPNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: (j A H-eYCd 20 Ol j cil —,,vwt <br /> t <br /> a !1d <br /> CONTACT INFORMATION <br /> OWNER NAME: 7,17 L/0 (!(/"q ,, �TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET, (2(/�7- OR e Q <br /> CITY L/ � `�r 4l 1,11A- <br /> CONTRACTOR <br /> �/ STATE A ZIP <br /> � 0 � / <br /> OWNER PHONE: �{Z�j /l OWNER EMAIL: v 1A' <br /> CONTRACTOR NAME: In House Electrical Services, Inc. <br /> CONTRACTOR ADDRESS: STREET 1530 117TH DR SE <br /> , Lake Stevens STATE WA zip 98258 <br /> CONTRACTOR PHONE: 425.760.3203 CONTRACTOR EMAIL: help@InhoUseelectric.com <br /> CONTRACTOR LIC.#(REQUIRED): INHOUES952QG ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.760.3023 <br /> Kelsey CONTACT EMAIL:kelseyreevesjc@gmail.com <br /> AGREEMENT.,/hereby certify that/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 /> ?/2s �� E I� 0 �`,L. <br /> O -/Authorized Ar natur Date (Revised 9/23/2016) <br />