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AP95?5-4025.4rl ;?23:5 ' <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everettepsoeverettwa.gov I WWW.eVerettWa.gov/permits <br />.................. <br />PROJECT <br />BUILDING AREA (if residential, new construction, remodel, or aciddon) SF <br />-BUILDING TYPE. 11 SFR-DETACHED El SFR-ATTACHED 0 DUPLEX [I MULTI -FAMILY - # or UNITS: COMMERCIAL <br />NG: 90C_Tkt& Rvlge� <br />CONTRACT PRICE OF WORK: $ 3-7 <br />NUMBER OF DEVICES (if low voltage), <br />FIRE ALARM? M YES M NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: <br />4' <br />OWNER NAME: TENANT NAME If Gommerclal), <br />OWNER MAILING ADDRESS: ST.EEI 1Q SOX <br />MY STATE W14 z,dfl2 22,07 <br />OWNER PHONE, <br />OWNER EMAIL, <br />CONTRACTOR NAME: eP1L)57_7ZY_erL12A_J <br />CONTRACTOR ADDRESS: STREET PO 60X <br />ITY STA�AA* <br />CITY,, <br />-mu'r— <br />CONTRACTOR PHONE: 426"21'q_044 IGONTRACTOR EMAIL: ktg/ . 8AM1Y)E-f_& k4_rW17-. <br />CONTRAGTOR LIC. #(REQUIRED): 6C-AlEeCo 407- <br />ICITY OF EVERETT OUSWESS LIC. #(REQUIRED): 040522 <br />PRIMARY CONTACT: DOWNER --Pill CONTRACTOR El OTHER (Please Specify) <br />CONTACT NAME: ICONTACT <br />6P_oV1 ICONTACT <br />PHONE: <br />EMAIL: DELIN I kIE-1411 T- I-OM <br />AGREEMENT-T hereby cartify that I have read and examined this application and Maw the same to he true and correct. All provisions of laws and ordinances governing this <br />type of wort will be completed whether specified herein or not The granting of joannit does not presume to give authority to violate or cancel the provisions of any otherstate or <br />local law fegulaffng 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 I <br />comply with the State Contactors Law 18,27 RoWand 296.20d WAC, <br />own.+011A.-rim-ed Agent Signature Date <br />City of Everett Offlciel Use Only <br />FEE <br />PERMIT# <br />E � qo::::( -o�3 <br />(Revised 1011212015) <br />