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"1"d"- 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.go Wpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5 6 0 9 /DC7 74' , , u/ .i e",e fit- 9'8..203 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ®SFR-ATTACHED- ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 4e.,1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ a00..94. <br /> Ca <br /> NUMBER OF DEVICES(If low voltage): / <br /> FIRE ALARM? 0 YES arm <br /> ASSOCIATED BUILDING PERMIT#(if applicable): •DESCRIPTION OF WORK: leXC/Zith4 GaS Pu"-net !e ✓'eeohneC71- C-)7=S7ct/T.-- <br /> CONTACT INFORMATION <br /> OWNER NAME: /4 6A-41- //i.4w ( P de er TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Sa-er)dew • <br /> CITY STATE ZIP <br /> OWNER PHONE: 9025- r73 -/t0 V OWNER EMAIL: <br /> CONTRACTOR NAME: �0 r c 0 5/e.c/s^ %C <br /> CONTRACTOR ADDRESS: STREET �py/5 / 7a P,o� S 7 t" <br /> cnv EDitdS STATE k'6. " ZP /dt)"C <br /> CONTRACTOR PHONE:62a- 7/y ^ ! Y°2/ CONTRACTOR EMAIL: Cot," C-//9 (o,.-vets t. N e t <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):00257?‘ <br /> PRIMARY CONTACT: j8.OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTA/cT NAVE: CONTACT PHONE: '" .6-- 773 /810# <br /> /4dl/1 A Aa int 6 e t e4 CONTACT EMAIL: <br /> AGREEMENT-I hereby certify that I have read and examined this application and know the same to be true and correct AN 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 slate 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 298.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> .i.-if (P /1-- /a <br /> ;"4 E 1 - -- ( i -0 ( 9 <br /> Owner/Authorized Agent Sig t Date (Revised 9/23/2016) <br />