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ELECTRICAL PERMIT APPLICATIO <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 t www.everettwa.gov/permits <br /> _PROJECTSilt INF.. RMATIOI <br /> PROJECT ADDRESS 5 1� � P'l a <br /> • • tt Q� <br /> BUILDINGAREA(iiresidential,new•.cort traction,remodel.or addition) L.SD.l SF _.. �_.. <br /> BUILDING TYPE:_0 SFR-DETACHED AZ-SFR-ATTACHED....0 DUPLEX 0 MULTI-FAMILY-#OF UNITS:__. _ 0 COMMERCIAL <br /> , USE OF BUILDING: <br /> . <br /> ELECTRICAL APPLICATION`INFORMATION `' <br /> CONTRACT PRICE OF WORK:$-1 ,C,�7 <br /> NUMBER_OF DEVICES,(iflo+w voltage) __. ___---- <br /> , . <br /> FIRE ALARM?._ YES. 0 NO <br /> ASSOCIATED BUiLDING„PERMIT#Of applicable) <br /> DESCRIPTION OF WORK �A A �,,/�� �/ <br /> CONTACT INFORMATION <br /> OWNER NAME CiJIG'C'1 C 911 Ll9 ..__ __ TENANT.NAME(if Commercial); _ :i <br /> OWNER MAILING ADDRESS. STREET t,1 b0 , A L_ii ry J iL.(/ 5T H. ..00 --. <br /> ___.:..._-.._- crrY W6641an�d. f L111V STATE wOR <br /> ;13�� ._. <br /> OWNER PHONE: OWNER EMAIL: _. ___.. .__._ ._..._ <br /> i __.... <br /> CONTRAOTOR NAME ' ” V1 T • tti '..c, - YL�._ _ _._._. <br /> OONTRACTOR ADDRESS: _ STREET. el!50.rr_.. 10 g7---.._ _. -• <br /> -- .. • - _ girt' CovirlA 1--an - - ,.STATE vJA....�..... ZIP CtIo t2 <br /> CONTRACT:.OR;PHONE 'Z,S:3 af¢31 'lSOX'4:671:1 CONTRACTOR EMAIL: p&Yn 43',D lm+NPark,t _ _ <br /> CONTRACTOR LIC„}{RE#UIRED).: P I I��-1 �,' �:CI'tf_OF EVERETT BUSINESS LIC ;#(REQUjR ED) o..;.33'Z;q_ <br /> PRIMARY CONTACT ❑OWNER DeONTRACTOR 0 OTHER(Please Specify)_ <br /> Shetrinin CGtt�le�#. _ _ <br /> CONTACT NAME: CONTACT PHONE�Zs 33( -77SO OZ$ — <br /> CONTACT EMAIL �Jt rsr trks. ,, <br /> AGREEMENT:!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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC_ <br /> City of Everett Official Use Only <br /> PERMIT# <br /> LI _ift 11 E ( -20 '41�i <br /> 9 9 . <br /> Owner/AufhorTzed'A-ent Sl nafure _ Date- '`(Revised 9/23/2P16) <br />