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„,,,,,, ,,o,,' _ ,_.,-: ELECTRICAL .�ERMIIT APPLICATION
<br /> ;TION
<br /> E, 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 I www.everettwa.gov/permits
<br /> PROJECT SITE INFO'afiATI4N
<br /> PROJECT ADDRESS: ,;,2e;:;..,D.,
<br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF
<br /> BUILDING TYPE: DI SFR-DETACHED El SFRATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: .gA>1 Lo (' 5 ,
<br /> IELLECTI•OC .L APDL ICATIIO,, INF, ”1, AT1l r!
<br /> CONTRACT PRICE OF WORK:$ 3,5 0 C c2--(--
<br /> NUMBER
<br /> 2NUMBER OF DEVICES(if low voltage):•
<br /> FIRE ALARM? ❑YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):1
<br /> DESCRIPTION OF WORK: ?Or-;T I CA y ,¢k.'J'`AS...--*'-- v,0 6 7z2 1 Ut iC>ca v ti..a,,)o,
<br /> CONTACTINFORMA'TIOPd ..
<br /> OWNER NAME: r rel s Ui .f q.„4---"' TENANT�NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREEr 7 7. . ,.5 '7 t'_ NF i�
<br /> en, n)1^'-4,s \r\ STATE(, 0 . ZI N(;)1 0
<br /> OWNER PHONE: %P....5 3 5'/ 0 -.2 0 Li OWNER EMAIL: ` ..
<br /> CONTRACTOR NAME: t '^CA SS1 t 3 (K'c'1-c' (c,, C,
<br /> CONTRACTOR ADDRESS: STREET .O ^'UX C Li.i)
<br /> cnY 9._,- ),();-V STATE `k3C1 _ ZIP g Q D 6)
<br /> CONTRACTOR PHONE: C 3c) ;31,5C)/ ICONTRACTOR EMAIL: n ( k Q''v . (tc " , (\el
<br /> CONTRACTOR LIC.#(REQUIRED): K„r),SS�C• j9°7f)(5--- CITY OF EVERETT BUSINESS LIC.#(REQUIRED)050J .)
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Li as r7 3-Lf —,�(--)
<br /> SSIe CONTACT EMAIL: N I
<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 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 /> Oa-
<br /> 4 160 _
<br /> (—N.
<br /> __,` ) PERMIT#
<br /> -V*
<br /> mariner/Authorized Agent Signature Date (Revised 10112/2015)
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