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ezlit-",lta 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: (731-1 `2 ' <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: E!'SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3 . LC) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? El YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): " <br /> DESCRIPTION OF WORK: t-, `„` ` - , .). _ t-et.--+- <br /> `." CAL-111 d re ez-,41 Y :I " -4-1.4016e(--___ <br /> CONTACT INFORMATION <br /> OWNER NAME: 'VA—) ) t yor-,ce e,^ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET � ✓ -�J s>4-4,--) p_ „6' p <br /> CITY t:„.r',,� 6�,.✓ STATE 143a.. ZIP Ci <br /> OWNER PHONE: Lii:4-4-j - c's C) °6 0 '`-- OWNER EMAIL: <br /> CONTRACTOR NAME:n C Yr6'1I,` *1 'yY\ ri`t a, Li''ICI I..- .. <br /> CONTRACTOR ADDRESS: STREET J / J eq 2' '' ter~ <br /> CrrY pm a../ S j" ¢ _ STATE 0,,‘,L., ZIP G."dy d ,,,+' <br /> CONTRACTOR PHONE: 4 ""--..275 "14 C - ONTRACTOR EMAIL: z;if 6 A.fi 2.(660- `3(f ` ,y ; <br /> CONTRACTOR LIC.#(REQUIRED):f' V v-6))431,—)A CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044 1 c4 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> -h.,2_ `mss, L' ' _.. CA i + CONTACT EMAIL: , tg'. ! <br /> .�- ° 1 . 1/ , <br /> AGREEMENT:I 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 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 I am authorized by the owner of this property to perform the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> IC t ( /471 ---6- / 7 E 1, I — so ( ;, <br /> Owner/Authorized Ag ri4 Signature Date (Revised 9/23/2016) <br />