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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( www.everettwa.gov/permits <br /> .... PR+t J t1I <br /> T SITE N MATlA1 <br /> t ' <br /> PROJECT ADDRESS: 5j .,/ .. ;s e 131 • <br /> BUILDING AREA(if residential,new construction,Ferfsodel,or addition),,„ SF <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDI G: <br /> CONTRACT PRICE OF WORK: $ o0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 <br /> ASSOCIATED BUILDING PERMIT# f applicable). <br /> DESCRIPTION <br /> D.ESCRIP.TION_OF WQRK:.. .. ___il' s II _ <br /> . _., ;coot>Ad Ifo tib At"io <br /> OWNER NAME: 4 A A , " ft s g TENANT NAME If Commercial : �. <br /> OWNER MAILING ADDRESS: STREET <br /> - 3'c11verlf al U <br /> ccrrv1eT `C <br /> sTATe LA✓ zR <br /> ♦:20 <br /> OWNER PHONE:425 3Z7 og � [OWNER EMAIL: <br /> CONTRACTOR NAME: C r) 11.9.-CAZi 0 9 <br /> CONTRACTOR ADDRESS: STREET )L (- lat'D atChiUt <br /> • �cITY ��C r4 t zla )5 20 <br /> CONTRACTOR PHONE: a5r 5 0%.-Z> [CONTRACTOR <br /> STATE CONTRACTOR EMAIL: ( t e '0r C. h6„„inQ r W. <br /> _ - CONTRACTOR LIC.-#(REQUI in):Cr -% I t jn <br /> CITY OF EVERETT BUSINESS lIc.#REQUIRED t - ' <br /> PRIMARY CONTACT: 0 OWNER .. .. T ( } r <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �[ <br /> ) },�� CONTACT PHONE: L ISS q D+1� <br /> `' -' le CONTACT EMAIL: � • . <br /> •Cern <br /> AGREEMENT:l hereby certify that 1 have reed end examined this application and know the same to be �nd correct. All provisions�nsolflaws 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 /> 4___ <br /> ALLL 'utwo ,e/,24.787 E ( OH — i9.01 <br /> Owner/Authorized Agent Signature <br /> Date (Revised 9/23/2016) <br />