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4trr 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 vwvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: /Z 1t✓E'i°&// VA, I. 2 L( — <br /> BUILDING AREA(if residential, new construction,6-emodel�, or addition) 2S?) SF j GGA <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX MULTI-FAMILY-#OF UNITS: 1.5� ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ (ZOO 0 0°,- <br /> NUMBER <br /> °iNUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES INO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / o / <br /> DESCRIPTION OF WORK: �rl(lr!t it gig L. 0e- j btaaei✓J� ���j hoc Rep4cLh <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Pv c r <br /> CONTRACTOR ADDRESS: STREET /'7j'75" a 7 /- E <br /> CITY G f"l ca^t roe 'STATE I/v j- ZIP r)--7.2 <br /> CONTRACTOR PHONE: 17i2.�- 4 t �- (6",,f LI CONTRACTOR EMAIL: L/'e..:qCZ; Rri-C-2GCcV"i <br /> CONTRACTOR LIC.#(REQUIRED): PAC IsI L * 3,2 ( CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER [Si/CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:/ CONTACT PHONE: ZJ (i <br /> 5 I:4'/` - '� CONTACT EMAIL: s,7,�'_ <br /> ,� � �/'C c.fi C - �: <br /> b <br /> AGREEMENT'I 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 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 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 /> • <br /> City of Everett Official Use Only <br /> PERMIT# <br /> l _ l 7 E 10'1 <br /> Owner/Authorized •gent Signature Date (Revised 9/23/2016) <br />