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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 ( FAX 425-257-8857 ) (E)everetteps@everettwagov( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION " <br /> I, PROJECT ADDRESS: fl 141 ' .Lt , :.: <br /> BUILDING AREA(if residential,new co tmcgoni remodel,or additions SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED CI DUPLEX JR,MULTI-FAMILY-#OF UNITS: 01 0 COMMERCIAL <br /> USE"OF BUILDING; . <br /> ` ELE CAS.APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK. $10.00 <br /> NUMBER OF DEVICES(if low v.tallej: <br /> FIRE ALARM? 0 YES , NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable) <br /> DESCRIPTION OF WORK A ,� A f,XsAJer :r S � � u1O s144 iel,5 <br /> I it.i, 1' : A,^. ,, t, P ' 4...4 I>(�}24 .. .,. , . <br /> • <br /> -.. -. <br /> CONTACT INFORMATION <br /> OWNER NAME:,.)c, kAPC4Cnil TENANT NAME,(If,Commercial): <br /> `Slv <br /> l2.,°tL 7 ,M - <br /> .l...k NE 4 11? <br /> OWNER MAILING.ADDRESS: STREET <br /> CITY Fc-, A w STATE YM.,r,..i ...._... .. __zIP 61939 <br /> OWNER PHONE: 91..5 $it:--3900 _OWNER EMAIL: NJA q <br /> CONTRACTOR NAME: r.!CUY t i " 6IQ,( .I' : ., <br /> CONTRACTOR ADRRESS: STREET ""0 "` <br /> -CITY ••• STATE .� ZIP 10 <br /> CONTRA(TORPHONE.u I4,O3V•l c( CONTRACTOR EMAIL: per IM% t ," ° '- <br /> CONTRACTOR LIC.#REQUIRED: P (CITY OF EVERETT BUSINESS LIC.#(,REQUIRE•i z 04c33241. , <br /> PRIMARYJi(' NTRACTOR 0 OTHER(Please Specify).- ,, <br /> CONTACT: 0OWNER CO <br /> 5hannnn (,ha,t 253-(p -1 7 SG��_���� <br /> CONTACT NAME: CONTACT PHONE: �_40�D <br /> CONTACT EMAIL: P' tMI 1 ,vvd4,r4e� kT c•v e4- <br /> AGREEMENT:I herebycertifythat I have read and examined this application and know the same to be true and correct Allprovisions of laws and ordinances pp' 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 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 /> y., <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ' . p. 1-7 E k <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> PI La3.1. Call xr cT143-4- cad ()ay m eery <br />