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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 J (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECTSITE INFORMATION <br /> PROJECT ADDRESS: 2214 Pyn 5-1- <br /> BUILDING <br /> tBUILDING AREA(if residential,new construction,remodel,or addition) 2,ZDC) SF <br /> BUILDING TYPE: ❑ SFR-DETACHEDO-SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> UOF BUILDING: t Cx 4� le ( <br /> SE exr t 51> <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Q <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: P & '-t, S D��: 7- t <br /> t <br /> jj CONTACT INFORMATION <br /> OWNER NAME: I mo LTJ t tri, TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET ,,t2 t"F <br /> CITY 1, STATEWA_i.1A_ z'P 112 1? <br /> OWNER PHONE: 6O b31 3-7-39 <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: A P_ <br /> CONTRACTOR ADDRESS: STREET 113 t (n A-) <br /> GTY Arj"Off STATE AM ZIP 6 <br /> CONTRACTOR PHONE: 360 -1C)3—0515 1CONTRACTOR EMAIL: Gr (n a1�0(2�'lrc4rwc fni;n, e w7 <br /> CONTRACTOR LIC.#(REQUIRED): kfS1rtP_X-X Q 3-7)C j ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): 6 3,�AJOA/ <br /> PRIMARY CONTACT: ❑OWNER 101CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NA CONTACT PHONE: Z/,4 <br /> Q <br /> u Ss (c i L 7 �! CONTACT EMAIL: ,Its, /camrt s 417_5,0. Ccrr <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. At/provisions of taws 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 or <br /> local law regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the Slate Contractors Law 18.27 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> So <br /> PERMIT# <br /> ;7 E <br /> Owner/Authorized Agent Signature Date (Revised 10/12/201.5) <br />