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,4P ELECTRICAL PERMIT APPLICATION <br /> gj_ 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.gov/permits <br /> PROJECT SITE:INFORMATION ``� <br /> �.., e4.. .M..+v.z z�f ,. �^,.. -.Y.S;,.�..+.=....;�z.,.,�., ;sg,f ..:,�...�r,.,.f__ ,.. ..'?.: ::, -, ...s .,..r., ,�. ,. .,.....�.:: ,-,.-. ,> _. . .wr;,-. i ,... a.... .,., .*.'. <br /> PROJECT ADDRESS: lea,7 ,L� /�}'L /�f/�i �yl/C�L 7 9-717 <br /> BUILDING AREA(if residential, new construction,� tiremodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED I 'SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: '1/Tl4Cr <br /> '' ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ t/cL. -471-7 <br /> NUMBER OF DEVICES (if low voltage):�/ <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: rtioit7 teVLv/CCS' G69�711v�'! <br /> ,. f CONTACT INFORMATION <br /> OWNER NAME: IV/L(, /34/t09- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: 36,0 ''37 3--75-262 OWNER EMAIL: <br /> CONTRACTOR NAME: 4-1e'(�t¢ e -C-T,e-rC <br /> CONTRACTOR ADDRESS: STREET 7OQ /3e2/cya.,c/ 13L-vp <br /> CITY evex477STATE P////f' ZIP 92 Zo 3 <br /> CONTRACTOR PHONE: t/2 7 4b/9' CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): TeG�6' �/LO CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0S-� Z <br /> PRIMARY CONTACT: 0 OWNER LP]CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:j�y�1 CONTACT PHONE: /Z ?���� <10/9f9 <br /> vv!)UU7/7 CONTACT EMAIL: /4„..4,r E792/ o. S-' I7€Z�. <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 /> City of Everett Official Use Only <br /> PERMIT# <br /> e EI'l09 021 <br /> wner/ uthorized Agent Signature ate (Revised 9/23/2016) <br />