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• <br /> grr ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5 `f) FC—CE 14 10 E7 ST <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED tiiia DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1, t IC °t% <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES X NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: AOD 5 - .Sr‘.tc'.1tci✓ F.-rt,_,et' <br /> h Z, �46-e OR)( P.i sX c.4' subtt ,,i-(zs <br /> 3 <br /> CONTACT INFORMATION <br /> OWNER NAME: d F N N($ ( U TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: `(mai 3.Z 3— `{a. OWNER EMAIL: <br /> CONTRACTOR NAME: (`'( < k <br /> CONTRACTOR ADDRESS: STREET 3'j( 5 S(-+csC.. Sc <br /> CITY y(=SZ<2� STATE L' ZIP ?82.Q <br /> CONTRACTOR PHONE: `(2,-3 3 c e 3 CONTRACTOR EMAIL: l•-•k`V<N< )( G (`-kkIC— <br /> CONTRACTOR LIC.#(REQUIRED): N F L c 3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): : 3 a 3c, <br /> PRIMARY CONTACT: ❑OWNER ®,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: h.QL�cN 9( CONTACT PHONE: Y� �G (��; C{ 3 <br /> VLl► tai-_ `� <br /> CONTACT EMAIL: J <br /> AGREEMENT:T hereby certify that I ha e 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 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 /> FEE <br /> o o <br /> PERMIT# <br /> 9 — 7 En6q ' , 5 <br /> 0 ne A4uthorized Age t nature Date (Revised 10/12/2015) <br />