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41177 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: 6."'/20 V i✓ $07- L-MJ <br /> BUILDING AREA(if residential, new construction, remodel,or addition) �tC' SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: S 14-/e <br /> ELECTRICAL APPLICATION INFORMATION ": <br /> CONTRACT PRICE OF WORK: $ q5'6)0°� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES i'NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: fq.:Ci�151.,t_ tc\1'"C.,k C- 3 <br /> CONTACT INFORMATION <br /> OWNER NAME: t h Ciu2Iv S(t,( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Cf 2 0 S u4JSE7- L/}fsi- <br /> CITY 4v a ASTATE W6 ZIP f z O 3 <br /> OWNER PHONE: 4'2 S 330- £ (O P TOWNER EMAIL: <br /> CONTRACTOR NAME: /4 CC"(f‘i Ty <br /> EL.Ece R.CC:� C.o (V C... <br /> CONTRACTOR ADDRESS: STREET 3 57 S tf og.r S p <br /> CITY c(ve.,2_ , STATE L41' ZIP Beat/ <br /> CONTRACTOR PHONE: 4125' 3 Q g 0(0 Q 3 CONTRACTOR EMAIL: M C=6CIV " aL(.T RQ. g M(\('L- <br /> CONTRACTOR LIC.#(REQUIRED): MC.-`j i IJ f C. fJ T CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0,r3'10 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4}'2 S 3 0 �' - G ,Q 3 <br /> 01 P(cE 'M C&(&)-1 }(' CONTACT EMAIL: S e- <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 /> 1170 - 00 <br /> PERMIT# <br /> /� if '-t7_ `G E IS.ol -1( O <br /> Owner/AuthorizedAgenatre Date (Revised 10/12/2015) <br />