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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)everefteps©everettwa.gov j vuww.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: el*?oc.t..... e,,,4,,,g0Mn'4i /4 v '.. <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ���FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: f/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ' `6i,- <br /> NUMBER OF DEVICES(if IOW voltage): CO `° - , , ,, , c./., , ,,,V "/ <br /> FIRE ALARM? 0 YES . 0140 c <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ifdel kelt,, ei itaLer i'-`41,02, t`{ <br /> CONTACT INFORMATION <br /> OWNER NAME: NJ 1 hI TENANT NAME(If Commercial):. <br /> OWNER MAILING ADDRESS: STREET 14724 atiell k <br /> po- <br /> EITY w...+ C--".k.e; - STATE tt,714 ZIP <br /> OWNER PHONE: 2040. --ei t �.I 73 OWNER EMAIL .) bIi( I5°7ci (6144 <br /> CONTRACTOR NAME: - �,,'c«,E - <br /> CONTRACTOR ADDRESS: STREET %( , aq t „,,.. <br /> CITY — STATE 14,"...E ZIP t I <br /> CONTRACTOR PHONE:cif-7V 3// ' CONTRACTOR EMAIL: ice. Ci6 <br /> CONTRACTOR LIC.#(REQUIRED): tr� F+J�.t r CITY OF EVERETT BUSINESS LIC.#(REGIUIRED1: , `g <br /> PRIMARY CONTACT: El OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'c <br /> CONTACTEMAIL: c <br /> + <br /> AGREEMENT`I hereby certify that I have read and examined this ape/tat/on:and know the sante to be-Yrue 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:perrnit 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 /> L.....m , is_r4 <br /> �� City of Everett Official Use Only <br /> PERMIT <br /> �,- E i 05- 13'b <br /> Owner/Authorized Agent Signature Date (Revised 9123/2016) <br />