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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 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3 O S (A p fr . J -v- <br /> BUILDING AREA(if residential, new construction, remodel, or addition) (KW SF <br /> BUILDING TYPE: 0 SFR-DETACHED IA-SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ti 2_5O <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES ANO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): n <br /> DESCRIPTION F WORK: �iusku V �, � I/rout- �1VkIU S - C ' <br /> & <br /> o.)ce7 ‘ e � ;' Si a,N-) C-WAS —Ftir1/\ <br /> 4 owpx <br /> T� � <br /> CONTACT INFORMATION <br /> OWNER NAME:, (I V�e,.35� <br /> , ,`Q-�l S TENANT NAME(If Commercial): 1/k) <br /> OWNER MAILING ADDRESS: STREET t820 ( 1V Offs 1-) <br /> �cn (�p j(Z) /�A • J k C L STATE <br /> �Q�Lk) z //32 <br /> OWNER PHONE: <br /> 11ZS ".1.. 2A `� OWNER EMAIL:ji M «J 1�1�-'�L� P.) Fi e �,(n,.V <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: -1CQWNER 0 CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Cj I-2 •l <br /> Q-4js CONTACT EMAIL: k,6('�S LA, (C.3}/V\ <br /> AGREEMENT:T 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 <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 l 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 /> 00 <br /> / PERMIT# <br /> / 2 -Z -201 (p E jJ1C9r2.- ©o , <br /> Owner Authorized A'Signature Date (Revised 10/12/2015) <br />