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ELECTRICAL PERMIT ARPLICATION <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 www.everettwa.govlpermits <br /> PROJECT SITE INFORMATIOPI' <br /> PROJECT ADDRESS:'1 (1 D 1-4 Q y'i A Je- <br /> BUILDING AREA(if residential,new construction, emodel or addition) SF <br /> BUILDING TYPE:)1SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: KQ , i ,,( ( ,,,s1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ zo a 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES X NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / 10 2 0 0 <br /> DESCRIPTION OF WORK: t\J cc,/ L t'�CL e ,. i• 1_o.Y r ./ C I c <br /> CONTACT INFORMATION. <br /> OWNER NAME: C( „\ .. e 1\4- j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t 1 1 14- .f ' i e. <br /> cm' f _ STATE uv ZIP <br /> OWNER PHONE: 9 ZS2-0GL.. , <br /> - 9 3 U <br /> d 3 OWNER EMAIL: <br /> CONTRACTOR NAME: cs�� €1 ecc-c i.C �+�^ <br /> CONTRACTOR ADDRESS: STREET i Iz 1�n y"j/ 'D I n V) � ^/ <br /> CI7y g+411 Wood STATE W � <br /> +�� ZIP 01 <br /> �2 v <br /> CONTRACTOR PHONE: if .3 21 S -, 'MI CONTRACTOR EMAIL:"I"(`e , e4 IC( 410,/ QJ� <br /> CONTRACTOR LIC.#(REQUIRED): 5 G e, CITY OF EVERETT BUSINESS LIC.#(REQUIRL ) 1. pL <br /> PRIMARY CONTACT: 0 OWNER 1 CONTRACTOR 0 OTHER(Please Specify) C®e 2' 001. t0 D '"t 6 <br /> CONTACT NAME: CONTACT PHONE: y- Z S 7 3 c 6&ZZ <br /> CONTACT EMAIL: <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 l 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 /> • <br /> PERMIT# <br /> Ykk 3 5 / a E 1 G <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />