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. � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE 1NFORMATION <br /> PROJECT ADDRESS: 4904 COII@ e Ave Everett, WA 98201 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED � SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: Sf �IVIII <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ZOOO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Paftlal attlC feWlfe, 4-6 circuits <br /> C�NTACT iNFORMATION <br /> OWNER NAME:�effy SI'1lltll TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT 49�4 COII@ge AV@ <br /> CITY Everett STATE WA Z,P 98201 <br /> owNER PHONe: 425.346.5869 OWNER EMAIL:n�a <br /> coNrRacTOR NaME: In House Electrical Services, Inc. <br /> CONTRACTOR ADDRESS: sTREET�53O ��7th DR SE <br /> �,n Lake Stevens STATE WA Z,P 98258 <br /> CONTRACTOR PHONE: 4Z�J.76O.3203 CONTRACTOR EMAIL: IIl@p@r11lItS C�1' glllall.COCII <br /> coNTwacroR�ic.#�REQu�REo�: inhoues952qg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044�6H <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,425.76�.32�3 <br /> kelsey coNTacr eMai�:ihepermits@gmail.com <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. A/l provisions of laws and ordinances governing this rype <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 o�the performance of construction. That 1 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 /> � � <br /> /j PERMIT# <br /> � � �'� �o � 2-`f� l-� E 1�l 1 � ` 2� 1 <br /> OwneG/Authorize gent Signa ur Date (Revised 9/23/2016) <br /> i <br />