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#.11jAELECTRICAL 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: 22.21 LQ F EN 201 <br /> BUILDING AREA(if residential, new construction, remodel, (r addition SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED ■ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ; CTRItAL APP CATION INFORMATION <br /> CONTRACT PRICE OF •RK: $ J i <br /> NUMBER OF DEVICES low vo - 1© CP\VI'Vve.C� 0-)1&14 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): L� <br /> DESCRIPTION OF WORK: VI �`o�VI V�ec� (ft ��VIv`g �. <br /> IN I T LQ <br /> 02 ej " S <br /> CONTACT INFORMATION <br /> OWNER NAME: �� �2�® ��.� \C__(y\ (. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2-‘Q o L 2 Y\e <br /> r g CITY m�,.k \ STATE \AI ZIP S©2 1 <br /> T 1 t(( <br /> OWNER PHONE: C .-%-)`7gs- 3 OWNER EMAIL: L I LEE Q 0 C AA.Ot�, ` C:::11,4/I <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 1 C CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) �r— <br /> CONTACT NAME: CONTACT PHONE: p(`rZ,�') ©7 —� f <br /> >J -2 �.�� CONTACT EMAIL: L�1 Lz. `�, l WIG�( <br /> 11 ✓ W "C," <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 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 /> ' og) 02.120 �'� E lig 02_2- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />