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^IP ELECTRICAL PERMIT APPLICATION <br /> 4 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 www.everettwa.gov/permits <br /> PROJECT ADDRESS: r <br /> BUILDING AREA(if residential,new construction,refade! SF <br /> or addition): <br /> BUILDING TYPE:` SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIALS <br /> USE OF BUILDING:> <br /> v RI I 4-,-7 I a <br /> �� "�' .<� >_ :. 4. '„� . ti .;. °�, a : '� 4 �� <br /> CONTRACT PRICE OF WORK. $ 0 .°2 <br /> NUMBER OF DEVICES if low voita.a <br /> FIRE ALARM? 0 YES S ❑NO <br /> ASSOCIATED BUILDING PERMIT#(If appltrable) <br /> _ 0ESCR1• ore. Ao.. ... _ 4 , 4 r12. " 'PC <br /> ' <br /> OWNER NAME: at 1.,. • A TENANT NAME If Commercial : <br /> OWNER MAILING ADDRESS.. *Isar <br /> .L <br /> • <br /> CRY A • is,.. ...... 109 <br /> STATE . . zip '. wii <br /> OWNER PHONE: 'a _ <br /> .. OWNER EMAIL: <br /> CONTRACTOR NAME ,Ail k 0. : ki <br /> { <br /> CONTRACTOR ADDRESS: STREET i i a CI 0 <br /> ctrr <br /> ..«o.�$_. P _ STATE ;•'� ZIP 2...o <br /> CONTRACTOR PHONE: i?# <br /> e., e„ I, Aer it CONTRACTOR EMAIL; <br /> rr <br /> in*'OF EVERETT BUSINESS L •t <br /> �' CCa#fOf1 �D-i�1.�-` e�< �e a _ 1�tC:#1 •Et��IIRED . r r� <br /> PRIMARY CONTACT: 0 OWNER ra. CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: I'" <br /> I "oblate CONTACT EMAIL ct» t "` C®1M <br /> AGREEMENT:I hereby certify that .have read end examined this application and know the same to be true and correct All provisions oflaw—a end 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 /> �� — iCc ( I <br /> otlar!Atttfltrzed Agent.8tgnature <br /> Date <br /> (Revised 9/2312016) <br />