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4"7- 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: 1 cb\t k*tAN Du\' 'Y — <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED <br /> I, SF�R,-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: '1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 600 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES th,NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: p lt'�l(Q CJ bate boct <br /> C ickoc keCove_c <br /> CONTACT INFORMATION <br /> �n �n �p ��p <br /> OWNER NAME: "C r 1 KIe�V()V\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY � �, pi STATE ZIP <br /> OWNER PHONE: � t �5-1� OWNER EMAIL: \ O\C& \(@,\NVT,, a ck., cov1/4-A <br /> CONTRACTOR NAME: N W e 1 Yom\ (al ,(� r <br /> CONTRACTOR ADDRESS: STREET ?, Y1 1(�,1. 0114- V" S `�a /� <br /> CITY �/r�1,--(A_VI"'` "'\ STATE Y I ZIP'"I <br /> CONTRACTOR PHONE: ?E' .�`6 vc 3(U 3 CONTRACTOR EMAIL: i\W 'QC..��C" v(al a VBG\\`• flit <br /> CONTRACTOR LIC.#(REQUIRED):EL ` (IIQ N p CITY OF EVERETT BUSINESS LIC.#(REQUIRED): quo <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n `( CONTACT PHONE: /.. <br /> 4S <br /> CONTACT EMAIL: t\ n(dr `lVnoT-�lu ( <br /> \• CJIj <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 /> /6 E (s®2 -D7,61 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />