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• I <br /> 477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERE i F 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.everettwagav/permits <br /> t <br /> .STTE�-. ::;: <br /> .. •TNF , <br /> ATI• <br /> O <br /> . ... N :qtr: <br /> .. ...... . : i;.:'iRN.i :r:::^Fi:'.`.•i:'%.,:j?_sissy:: <br /> PROJECT ADDRESS: 1 op 17 ;nom <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: 7 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> i <br /> USE OF BUILDINGt: 4\.1 / <br /> .....:.. <br /> 7'R PAILAfTPI is <br /> CONTRACT PRICE OF WORK: r.:.:••::::.:.., :::•:;•,:.:::.:;::;;,;:;::::::::::::;; ;;_,:;;>;,:.;.:.;.::. :.;. <br /> $ C� � �D <br /> NUMBER OF DEVICES(if law voltage): <br /> FIRE ALARM? 134CES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: S Isp Ail 41 ('9-' <br /> 1 <br /> . .............. <br /> T INFORMATION : s::. :;•::::.;:, ;;.:::::.:,..::'.::: <br /> OWNER NAME: ; tCIV-U,.VE\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 Ot)1 ���-§. Q o <br /> en ",,,�QJ J- STATE i,/,....4.4,--• ZIP ,(J)l <br /> OWNER PHONE: Lt\...\:,-Z3f1 --". 7 i-O% 'OWNER EMAIL: <br /> CONTRACTOR NAME: (4 C c ( <br /> CONTRACTOR ADDRESS: sTRear •._a,-* A-2-- J <br /> CITY y PA LUA STATE Qc7�f3 z <br /> CONTRACTOR PHONE: -i�\".2S 4`(tare— / CONTRACTOR EMAIL: l: t,;,vim Q., \jam ;. <br /> CONTRACTOR LIC.#(REQU[RED): ci-("( ..,�.s,Z ei20 4- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ,fcj(,�y-C•-' <br /> PRIMARY CONTACT: 0 OWNER 7QONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME - CONTACT PHONE: U") -7 ss---124‘..(6,2...- <br /> .. Gaut\ \LLAAtkkaA7 <br /> CONTACT <br /> - -- <br /> CONTACT EMAIL: (•rl;, 1 Q_aA , - s cev „. <br /> AGREEMENT.I hereby certify that I have read and examined this application and know the same to be true and correct. Ai)provisions of laws and ordinances governing this type <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 or the performance of construction. That!am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> • <br /> City of Everett Official Use Only <br /> PERMIT# <br /> y 611i 1 --1 E r-9 ‘ ‘ - 09.9 . <br /> Owner/AuthorizedAgentSignature • ` Date i(Revised 9/23/2076) <br />