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477 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 6q/7_,- / C/ -n/` , BA/L), <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE:I SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: b(S(jo5f,3 _t 4 . ry -t ) W-10— <br /> CONTACT <br /> 10— <br /> CONTACT INFORMATION <br /> OWNER NAME: 3 J 4 3 (1 (, (z TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET W/ /Z 1351) 13 tin) , <br /> cm, C..-IJL 2E ( STATE Le)A ZIP A. ZO 3 <br /> OWNER PHONj't?57 /Z /O OWNER EMAIL: <br /> CONTRACTOR NAME:64 (pr_,e,‘K-aN l'f 7 I �' /1/6.1 <br /> CONTRACTOR ADDRESS: STREET 2.1 P4Ci L rr//�� <br /> CITY STATE (�. � ZIP 4?-50240 / <br /> CONTRACTOR PHONE/ f-Lc) 2z —3( 4 CONTRACTOR EMAIL: f-«'ti..)aG' tt �_Ct..r i'g-t <br /> CONTRACTOR LIC.#(REQUIRED): 52G �s� �jyf, H- t4r 1C CITY OF EVERETT BUSINESS LIC.#1(REQUIRED):oC37` 5T <br /> PRIMARY CONTACT: 0 OWNER 4]CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME• CONTACT PHONE: -' ZS Z 3/ ( . <br /> CONTACT EMAIL: J('2�, S�/ ,Qe.©i4 <br /> AGREEMENT:/hereby certify that 1 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 /> E \- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />