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ENCTRICAL PERMIT APP&ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ( (E)everetteps@everettwa.gov ( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 t1 `(7 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: I ;SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> iftirg;T CAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ , <br /> NUMBER OF DEVICES flow voltape , <br /> FIRE ALARM? DYES.__ in NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable) <br /> DESCRIPTION OF WORK: No #r algae) <br /> arold ( tivea Vit ' ' I> G ta; ►G. <br /> �. .. -. m ° TION <br /> OWNER, <br /> OWN NAME: t" s *, ' S TENANT NAME If Commercial <br /> OWNER MAILING ADDRESS: STREET 410 201'11 s ... <br /> Girt' : STATE ZIP 952o I <br /> ""` <br /> OWNER PHONE: 5C0Z-—2bq . 15?-44 OWNER EMAIL: <br /> CONTRACTOR NAME: Anna . L wiljk <br /> CONTCTO1t:ADDRESS: sraeeT jao, • <br /> CONTR TOR:PHONE: . O'S Z CONTACTOR EMAIL * Ai • 4040 , . (1r1 <br /> CONTRACTOR LIC.#(REQUIRED. 1 .„...14,4ksoir. 4 CITY OF EVERETT BUSINESS LIC.##REQUIRED: , • <br /> RIMARY CONTACT: 0 OWNER 151 ONtRACTOR. 0 OTHER(Please Specify) ..:. <br /> CONTACT NAME: CONTACT PHONE: 40 M *mow <br /> CONTACT EMAIL.' $ .,er .. + > m j(ID. <br /> AGREEMENT:T hereby certNewify rtify that t have read and examined this application and know the same to be true and correct. All provisions of laws and « aces 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 stale or <br /> local law regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use only <br /> FEE' <br /> lOC) �— <br /> ? ',. PERMIT# <br /> 1$ <br /> E <br /> • �� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />