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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECTADDRESS:ZI(� uq,r :so� ��/'L Evc�e� WA �g 2J1 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) kTo,e1 SF <br /> BUILDING TYPE: ❑SFR-DETACHED B SFR-ATTACHED ❑ DUPLEX ❑MULTI-�AMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECT ICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:N�$ 3 � o� ; l D <br /> NUMBER OF DEVICES(if low vplta e): <br /> FIRE ALARM? ❑YES � ❑ O <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> DESCRIPTION OF WORK: 20o u I <br /> CONTACT INFORMATION <br /> OWNER NAME: �,rne5 � �c?� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT ZILI �Iu�r�Sw AVe <br /> ciTv Eve � STATE �(A ziP Q`62U� <br /> OWNER PHONE: Z,S- �I�oU- y�{'I 9 OWNER EMAIL: 5�al '02 04 Q (�olmw •tVrn <br /> CONTRACTOR NAME: �j �� I LLC <br /> CONTRACTOR ADDRESS: sTRe�r 1.q (U 1�+ �e..��In ��,.0 <br /> ciTv Se��4 srnr� W� zia q,�131� <br /> CONTRACTOR PHONE: 1I2T � (,g3� CONTRACTOR EMAIL: So�a�admi� o��u • ' �` <br /> CONTRACTOR LIC.#(REQUIRED): ' L C� L$3 �jZ. CITY OF EVERETT BUSINESS LIC.#(REQUIRED. <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2� �r� (o� � <br /> �Q�� �V�„��( CONTACT EMAIL: So�ar a c� M�� �, Sa`�(r�.�(1 <br /> AGREEMENT:T he�eby certity that!havo road and examined this application and know the samo lo be true and correcL All provisions o!laws and ordinances goveming thrs <br /> lypo of work wi0 be compleied whether specified horein or not. The granting of a permit does not presume to give au[hority to violate or cancel[he provisions o/any othor state or <br /> foca!law regidating conslruction or the pe�lormance o!construcfion. That 1 am aulhorired by the ow�zer o(Ihis property to porlorm tho wo�k/or which applicatron is made and I <br /> comply with!ho Sfatc Confractors Law i8.27 RCW and 296.200 WAC. <br /> City of Everett Oflicial Use Only <br /> FEE <br /> �%� � <br /> v <br /> G/;� PERMIT# <br /> l�/�/� E 1�-�2 -O6�j <br /> ner! uthor ed Agent Signature Date (Reviscd i0/12/20i5) <br />