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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: 4, O rj Vaal-MO Rt. AV a. <br /> BUILDING AREA(if residential, new construction, remodel,or addition) 1 do SF <br /> BUILDING TYPE: $I SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: S-P\ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 5-Z3 0� mea <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES KNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): A)/74- <br /> DESCRIPTION OF WORK: ita ts.)P Q . i4ri c..f-(I Uo MA,S i?t2. 8 D/2 0c .e , Ay,) <br /> Mt'ts P Eet ait f tf-ftot <br /> CONTACT INFORMATION <br /> OWNER NAME: BOB .1►SUU. 1\k ae-ht4ALPty TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6 65 /.0-EriteIdit I1 I/J_ q <br /> crrY s O <fin"— STATE Le..) ZIP 9 8 Z 6/ <br /> OWNER PHONE: 'f:A5 2S8— ' - ( OWNER EMAIL: <br /> CONTRACTOR NAME: / c'Ca t 1 c f G t /Ltc- �. 4N I <br /> CONTRACTOR ADDRESS: STREETy{r/�� 575 ��„�Sf ty02 P ""Cr t� p <br /> CITY ri-Val2�-(1 STATE ZIP q \1/ <br /> CONTRACTOR PHONE: t{ .6" 3©a^ ®Go 3 CONTRACTOR EMAIL: NL iN 1'y k_ac f l2.`C 61•0.0.- <br /> CONTRACTOR <br /> 1.0. I.CONTRACTOR LIC.#(REQUIRED): M Ct3 tO__C-(10 3 N S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (D38 34 t <br /> PRIMARY CONTACT: 0 OWNER igr CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: e-fa�^ 3 6 e- ®Co Ct 3 <br /> VIA((c_n- C C.,cN rY' CONTACT EMAIL: S it.fr As A eut <br /> AGREEMENT:T 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 <br /> type 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 /> FEE <br /> PERMIT# <br /> � g- �a -�� E I �C'"(5(0CQ <br /> ' <br /> Owner/Auth ' ed Agent - re Date (Revised 10/12/2015) <br />