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,IIPP^z--_ __. 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.gov/permits <br /> :' PROJECT SITE'INFORMATION <br /> PROJECT ADDRESS: 'On 1 co<U j \\ _ <br /> BUILDING AREA(if residential, new construction, emode)or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION ' ' <br /> CONTRACT PRICE OF WORK: $ S IOM <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: SO -9c r.,¢Jt_ PO 0 E 0 (ot AN\.P. <br /> pp . - CONTACT INFORMATION <br /> OWNER NAME: ro�-tj C_,UY`J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1C)a &RAcIJD J <br /> - 4, <br /> l 1-t CITY A rt STATE ZIP <br /> OWNER PHONE: 3.0k0 C \ D)2.14 OWNER EMAIL: <br /> CONTRACTOR NAME: i'l1S V'N k,€4....Nr (C.-- <br /> CONTRACTOR ADDRESS: STREET \'Jb ) t-ka or .0 <br /> 4NkbrAi 5 CITY (WA- STATE I�Gy r/ ZIP <br /> CONTRACTOR PHONE: 0A.).9\--:‘42.-*183'S1) NTRACTOR EMAIL: p <br /> CONTRACTOR LIC.#(REQUIRED):42S- 2Gff 55-g CITY OF EVERETT BUSINESS LIC.#(REQUIRED)O \2 <br /> PRIMARY CONTACT: 0 OWNER rx CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42 0_61 <br /> s:5- / <br /> frc, AtçI (\ CONTACT EMAIL: ii-us Tn2i ce GCS C_/ //i 0/14 <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 a 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 /> c/z zo (7 EnD5--0IS <br /> Ow er/Authoriz Agent Signature Date (Revised 9/23/2016) <br />