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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 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ,96' <br /> BUILDING AREA(if residential,newcon ruction,remodel,or addition) 1-S 1 SF <br /> BUILDING TYPE: 0 SFR-DETACHED ,IirSFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING:. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$7 V310 <br /> I <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable); ___, <br /> DESCRIPTION OF WORK: tW 1 0^ ? JF = <br /> CONTACT INFORMATION <br /> OWNER killp <br /> :.. � L V TENANT NAME�1D STE 1 C_ommareiat): <br /> OWNER MAILING ADDRESS: 11160 <br /> �. � Y I DRESS: STREET C I3 00 <br /> p /y� <br /> _ _..... CITY Wood' I- iI) -_. _.. STATE ,✓ _- __-.-.ZIP ci olio <br /> ✓��>. <br /> OWNER PHONE: OWNER_EMAIL: <br /> CONTRACTOR NAME: ,%t - t- '1�.c i`\c. (..__ _ <br /> CONTRACTOR ADDRESS: STREET QO Dox- 70 g7 <br /> ,AAAA ��e� .. Q'/�(J <br /> CITY CO <br /> VI _. STATE IA/A ZIP C__CfOT?., <br /> CONTRACTOR PHONE:IS3-(,3J- 7..C) oilt 'CONTRACTOREMAIL: .petnilb pY81Adm (;,.vtt�' <br /> 'r l <br /> CONTRACTOR LIC.#(REQU(RED): OV)&E-1.03Lt,, , CITY OF EVERETT BUSINESS LIC. (REQUIRED):Qy 33v <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 3-hAnrl.J' ' t - CONTACT PHONE: '113-0 1 `775"0 ' 1 0-1,g <br /> CONTACT EMAIL: ptf pj,,,vi -. ,Q( L,NLe4- <br /> AGREEMENT:I hereby 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 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 /> City of Everett Official Use Only_ - <br /> PERMIT# <br /> Alltyvv_____ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />