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477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 ( (E) everetteps@everettwa.gov f www.everettwa.gov/permits <br /> ...PROJECT SITE INFORMATION <br /> • <br /> PROJECT ADDRESS: 101 `E.` L fl f r/t 0 rvl.(3._() PAH <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 1 i g SF <br /> BUILDING TYPE:)FR-DETACHED D SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ r C( . <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: (")Ci ry,r) O(?i 1;s ( ,ra o <br /> I Ov <br /> CONTACT INFORMATION <br /> OWNER NAME: U; yea-qtr- TENANT NAME(If Commercial): <br /> I <br /> OWNER MAILING ADDRESS: STREET) J^ n 1 3 r IAA <br /> r1 c 4 <br /> CITY gj Lol }1r\1 Cy1/� STATE Illi i ZIP �i G}�ACi l t <br /> OWNER PHONE: L4as-;sI-1 OWNER EMAIL; <br /> CONTRACTOR NAME: fj Dm; n` <br /> CONTRACTOR ADDRESS: STREET �11/41t—) �,��pl �(,J <br /> cm STATE V'V ZIP )4 <br /> CONTRACTOR PHONE:Lac-II() -I.4—n CONTRACTOR EMAIL: _R O r e(,}c h o(' -11-}no, , COQ <br /> CONTRACTOR LIC.#(REQUIRED): C-JS JT(�s C3CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 01q <br /> PRIMARY CONTACT: ❑OWNER " CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> m � "P.7� '10!0,,, <br /> �s <br /> C.x . l �d CONTACT EMAIL: j",`: l"jp. o <br /> ( <br /> AGREEMENT:!hereby certify that I have read and examined this application and know the same to be true and correct. All provisio s 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!am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> I E1, I-' l <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />