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ELECTRICAL PERMIT APPLICATION <br /> T' a CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> u. <br /> PROJECTXSITE INFORMATION <br /> PROJECT ADDRESS: 30` W H- J�`arkof , <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: pp� l y�� (sm-, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ [O, 547[3 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES LINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 9,GO k rvi £z p kt.-C <br /> rcplouce. SVN4 - AnaC ? al�'f"t2 <br /> CONTACT'IINFORMATION <br /> OWNER NAME: F-p,t/r"(r, L. ?rC 4 e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREE c )j i1 - J('/\ <br /> CITY qt r _ J STATE v6 1 ZIP "C32-03' <br /> OWNER PHONE:�'lq'5-74- (Ar{L( OWNER EMAIL: C,tX{1/T-Ft C.e.. .�g 1 r'\dO. <br /> CONTRACTOR NAME: Se,a—reA A)r <br /> CONTRACTOR ADDRESS: STREET 'y--e-)A <br /> �/e1�-d-ctA,(Jcy---- 5� <br /> Coy /P/Y (�J l�� 8 STATE ik ZIP ot6 ZC, <br /> CONTRACTOR PHONE: > f %oat CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 0'6100 CITY OF EVERETT BUSINESS LIC.ft(REQUIRED) rr f (p <br /> PRIMARY CONTACT: ❑OWNER Il-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z —at -jam i d <br /> L (# ti CONTACT EMAIL: f�L-`d 1. ottr VN-e Le I4l�l C <br /> T: - lam <br /> AGREEMENI h�by 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 lam 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 /> . H. t n E <br /> Owner/Author • gent Signature Date (Revised 9/23/2016) <br />