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F--=9zs 4134Y.a.?5 <br />.-,? 7,59 <br />(P) 425-257-8810 <br />ELECTRICAL PERMIT" APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425 257-8857 ( (E) everetteps@everettwet.gov j wvww.everettwa.govlpermits <br />N T1 <br />R 9 <br />..n a 4J.•.i.'v::v4' '.ice <br />PROJECTADDRESS: <br />13UILDING AREA (if residential, new constructio i remodel, or ddition) SF <br />BUILDING TYPE: El SFR DETACHED ❑ SFR ATTACHED ❑ DUPLEX la MULTI -FAMILY - # OF UNITS: COMMERCIAL <br />USEOFBUILDING: �J � (� E <br />t��'y:.7 •1:: :�•g �s;r.P[' rdrr.; v.-�:� w-r•+,••w - • :.,�.:: ;'^•.in-':'r:c�•7R: <br />iii <br />1rA�g1.ORIV�{1�� 9' �.i•r-,•F}{,r�1i^..•ivl�...,'�r.:�t Ttl• r ..1: `'{•a . 1�� 1•�. <br />Lt. ,..4 a,,. ..'.i:.iv,•oJ�.i`�-.�oafCrka... : a.F�;. �..t.L��: i{•,•. •. <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltage). <br />FIRE ALARM? E( YES x NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: <br />4.x-�;. _. , . • � ... , ,G;O[i�'1'A,CT'INFO1t1f11�1T10N: .... - .. _ �-- .� :: _ - <br />OWNER NAME' TENANT NAME if Commercial): �G <br />OWNER MAILING ADDRESS: STREET SOX 31 <br />MY L�r 1FA-M rV� Zi82 "Z2-07 <br />WNER PHONE: <br />OWNER EMAIL: <br />ONTRACTOR NAME: <br />[CONTRACTOR <br />ADDRESS: srREEr Pd $OX <br />crr 1W9 ILMD srA /4 zm <br />CONTRACTOR PHONE: 6'4"1,04 <br />CONTRACTOREMAIL: /r, L'D/}'7 <br />LIC, #(REQUIRED): ��Nt ,E'C ADZ <br />CITY OF EVERETT FlUSINESS LIC. #(REQUIRED): QL%D <br />rGONTRACTOR <br />ONTACT; ❑OWNER HCONTRACTOR Ci OTHER (Pleaso Specify) <br />AME: <br />CONTACT PHONE:rY1+CONTACT <br />EMAIL: <br />AGREEMENT. - Thereby certify that I have read and examined this application and know the same to be true and correct All provislons of laws and ordinances governing this <br />type of work will be completed whether specified herein ornot. The granting ofa permit does not presume to give authorlty to violate orcancel the provisions of any otherstate or <br />locallaw regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and l <br />comply with the State Contractors Law 18.27 RCW and 296.20d WAC. <br />Ownar An orized Aganl Signature Date <br />City of Everett Official Use Only <br />FEE <br />PERMIT# <br />E rj()q-2H� <br />(Revised 1011212016) <br />