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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 /> litat•JECT I`ltl , POR 'li"1t5it"4 <br /> PROJECT ADDRESS: 73 2Z Jurow.p.e r b r <br /> BUILDING AREA(if residential,new construction,remodel,or addition) tF` <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> .. ell a 1 IINFTO111, _. <br /> CONTRACT PRICE OF WORK:$, rJ C ,oo <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> A. <br /> DESCRIPTION OF WORK: 1,i T .+ � <br /> , C <br /> OWNER NAME: 110. 10)d i o j * . TENANT NAME(if Commetc1at): <br /> OWNER MAILING ADDRESS: STREETr 2„,� .�vip„p or- r <br /> t.✓✓✓✓ i' _ {ry2 <br /> 03 <br /> OWNER PHONE: OWNER EMAII <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 11-41'51?$.6c4cits4.)an <br /> w� <br /> etr <br /> Ar2� <br /> CONTRACTOR PHONE:" i trZ +"""( <br /> . ;' CKJN'CftACTOR EMAIL; .�1 <br /> CONTRACTOR LIC,*REQUIRED);c,..n.th,e _ 'j""' del CITY OF EVERETT BUSINESS LIC.S./REQUIRED): 1100 <br /> PRIMARY CONTACT: 0 OWNER ' > 'CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 6 a q 0,513(:) <br /> , <br /> CONTACT EMAIL: * . a <br /> as #.f " in °, . <br /> AGREEMENT.'I hereby certify that 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 fo violate or cancel the provisions of any other slate 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 /> 0 kite., 0 9.2!_.L 7 E - v�� <br /> Owner/Authorised Agent Signatut Date r(Revised 9/23/2016) <br />