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ELECTRICAL PERMIT APPLICATION <br /> i' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-6810 I FAX 425-257-8657 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> P••40404::01** t > TION <br /> PROJECT ADDRESS: S2�0 .r� C ,k <br /> BUILDING AREA Of residential,:new construction,:remodel,or addltlon) SF <br /> BUILDING TYPE:�SFR-DETACHED 0 SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS; 0 COMMERCIAL <br /> USE OF BUILDING: <br /> Y°R �"�� ,A�,p. y ''',41/f ' <br /> �' . h:3 sib�,y <br /> Yit 1.4 .�,t =- ,�5 ' i ISE ,Icy 0pj A o 6 <br /> CONTRACT PRICE OF WORK:$ CD ,do <br /> NUMBER OF DEVICES If low volta!e ;. <br /> FIRE ALARM? <br /> 0 YES <br /> ASSOCIATED BUILDING PERMIT,# 8..licabie <br /> w..--DESCRIPTIONOF WORK.. :_ p `= v , _ __:::: <br /> ..!";,`",,,-,:1-`'''' <br /> "M, '' ; c ., ',:r�� X66 .k, 11$1g� [il s ,a,, r <br /> OWNER NAME: <br /> `•3 � i , a,"' TENANT NAME(If Commarstlttl); <br /> OWNER MAILING ADDRESS: STREET 1 O2C0 ( Carer <br /> C� �./T`` STATE ^` ZIP ei a 20 j <br /> OWNER PHONE: 42.5 �ti5 <br /> ...,,,.... .. �`� * OWNER EMAIL: <br /> iCONTRACTOR NAME:. C y . 0 f <br /> V,.. <br /> CONTRACTOR ADDRESS: STREET o • <br /> A - ., , <br /> CITY # <br /> STATEV <br /> t. ZIP 411111 <br /> CONTRACTOR PHONE 55 !CONTRACTOR EMAIL: i e, 9 i • <br /> r <br /> to s -� <br /> . . e-"fir .','LUti •"` 1Cr <br /> ,,_ a CITY OF EVERETT BUSINESS LIC #(REQUIRED), C <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: <br /> a*,• 4 0 le CONTACT EMAIL:a, 4, I,- tetectri i •c rY) <br /> AGREEMENT:I*MAO vediary that 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 windher 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 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 /> PERMIT# <br /> 12 " i '2 3 .IS E ZO1 _ <br /> Owner/Authorized Agent Signature <br /> Date <br /> (Revised 9/23/2016) <br />