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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 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: R L4 I -5 2.' 09-, v e Yot! . v..1 /�f A `)1 cbr„o cb <br /> BUILDING AREA(if residential,new construction,remodel,or addition) e S j 4/111-172/SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: �' j pitiAr (c(J . <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ X300 <br /> NUMBER OF DEVICES(if low voltage): 1\1 1 A <br /> FIRE ALARM? ❑YES ANO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): N /A <br /> DESCRIPTION OF WORK: 2 0 r, p C t r GLJt <br /> A .111—e) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1- 1 -j OA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET GN I 2,rid DY-.., 6 _ <br /> CITY -1S\te r Ai STATE 7%` ZIP 9%70 CO <br /> ( <br /> OWNER PHONE: A / ' 1j t0t `I 1 0 OWNER EMAIL: V. �1 a. lQ�l` (J Ct �1Z�D . Car <br /> CONTRACTOR NAME: Se'O71 L ti I G Co )• <br /> CONTRACTOR ADDRESS: STREET `lam 0 80 x h 53-c) <br /> CITY SPiZH 1 J STATE W A,' /� ZIP qb ?•5 <br /> (D' <br /> CONTRACTOR PHONE: 2Oco /O3 l O(CONTRACTOR EMAIL: 1 I'1 t'a))?MX Ei t i yi C .COm <br /> CONTRACTOR LIC.#(REQUIRED):SETQ UG ?Yap .6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):?jq <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: 2 oG Ras 3(i q 0 <br /> M a, CONTACT EMAIL: ma(44 a Sed-Due)e&clri c <br /> AGREEMENT:/h b certifythat I have read and examined this application and know the same to be true an orrect. Allprovisions of laws and ordinances governing-this type <br /> Y PP 9 9 tYP <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 properly to perforin 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 /> II <br /> I / 2 /I 6 E 1q0 - 1 8`1 <br /> Owner/Auth-rized A,e Si'nature Date (Revised 9/23/2016) <br />