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12/01/2017 09 : 46 #2973 P. 001/002 <br /> 45T7 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 J (E)everetteps@everettwa.gov r www.everettwa_gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: /t: S/, prill 4 <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED LI SFR-ATTACHED- Q DUPLEX CI MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: cp,N(44 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ T <br /> • <br /> NUMBER OF DEVICES (if low voltage): _ <br /> FIRE ALARM? LI YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /4-1,1-771. A tior ��GII7 s V <br /> CONTACT INFORMATION <br /> OWNER NAME: J E, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STMT /( j.t / ' e4J/F SE <br /> • <br /> OWNER PHONE: ,Z,S31_5. OWNER EMnAIL: �+ • <br /> CONTRACTOR NAME: fu_k_Av i <br /> CONTRACTOR ADDRESS: STREET 26 t'(&-K{rff '}mss_ <br /> c1Ty-f rn iT STATE 1j� �1 ZIP g/pS V <br /> CONTRACTOR PHONE: r .V 41 CONTRACTOR7� EMAIL:/ �✓ <br /> CONTRACTOR LIC_#(REQUIRED): 3 .FL. . 21P CITY OF EVERETT BUSINESS LIC.#(REQUIRED)4/ ,1`p <br /> PRIMARY CONTACT: 0 OWNER A CONTRACTOR ©OTHER(Please Specify)---Al <br /> CONTACT NAME: CONTACT PHONE: <br /> 0 Q x� CONTACT EMAIL: <br /> AGREFMf:N7 I hereby certify that t have read end 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/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 /> /2c4/7 ,_ E R12- - C 6g <br /> Owner!• t'rized Agent Signature (Revised 9/23/2096) <br />