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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 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION `•; <br /> PROJECT ADDRESS: 95-n 14 I t lav p 1 a(A, <br /> BUILDING AREA,if residential,new , / �t <br /> ( � ctiiSn,remodel,oratlditionj ��p� SF <br /> BUILDING TYPE: 0 SFR-DETACHED ,Ir-SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECAPPLICATIONTRICAL NFORMATIQN <br /> CONTRACT-PRICE OF WORK:$1.,O <br /> r7 <br /> NUMBER OF DEVICES(if low voltage): _.,_ <br /> FIRE ALARM? . NYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OWNER NAME: ! Ctrl , I1AA_ TENANTNAME Of Commercial): <br /> OWNER MAILING ADDRESS: STREET ti 3 to Vi airy rrJ <br /> crre WOOd Q� (its STATE c v ZIP qI3 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: V l- C- c. 'Ibtr. <br /> CONTRACTOR ADDRESS: STREET QQ WK 70 g7 <br /> cm, CbVi - .__ ._.STATE WPI _._. ZIPRqO Z _- <br /> CONTRACTOR,PHONE IS 3-1031-77SQX 6Z'$ CONTRACTOR EMAIL QZr(Y1ii4)MI)IA j , - DI G.y{,(4 <br /> CONTRACTOR LIC.#(REQUIRED) OV) <br /> 6 1-� Cite' CITY OF._EVERETT BUSINESS LIC.ilf(REta akED),Og 337.41 <br /> PRIMARY CONTACT: ❑OWNER AMONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 3hgnrt vtLait <br /> Cili1� PHONE:_CONTAGT <br /> 2.53031 .77.-ox 16-ig <br /> CONTACT EMAIL ,rY11tpY , G <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 tam 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 /> I E 1 47 D l '35 <br /> OwnerfAuthorized Agent Signature Date (Revised 9/23/2016) <br />