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LECTRICAL 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 /> - • PROJgCT.STE INFORMATION-- <br /> PROJECT ADDRESS: /*I ge) a-/ ( 2 ,-114, ,At 'I _e <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF - <br /> BUILDING TYPE: 0 SFR-DETACHED 0 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: <br /> NUMBER OF OF DEVICES(if low voltage):, / <br /> FIRE ALARM? 0 YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: y.frt61(*e £/ °1,914/7 <br /> - •CONTACT INFORMATION <br /> OWNER NAME: 1Z49p7 0 Gf 4 Cdki TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S 0 kl".0 <br /> CITY STATE ZIP <br /> OWNER PHONE: - 1/V- /57‘„ OWNER EMAIL: <br /> CONTRACTOR NAME: /(7&/-(0 / 4='efi--/Y <br /> CONTRACTOR ADDRESS: <br /> STREET <br /> CITY .5114-1 OAi STATE ‘1..' 1 ZIP <br /> CONTRACTOR PHONE;,W 7Jq.. 7re,77 CONTRACTOR EMAIL: Ca"r-c- ' ------ <br /> CONTRACTOR LIC.#(REQUIRED): ///ii)prdEr-75.8/e0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):a?5 Pi?„‘ <br /> PRIMARY CONTACT: Pt OWNER erZi CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / JA61-rOn CONTACT PHONE: a d9a' "zr3, — <br /> e•- lf'" cr/ DPICOrdi CONTACT EMAIL: <br /> AGREEMENT-T hereby erthy 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 <br /> type 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/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 /> FEE <br /> . q--- •-• ,,,------_ <br /> • <br /> ...." <br /> 1,,,..,/ PERMIT# <br /> ..," / /,9# , E \ gok -At4c <br /> Owner/Authorized Agent Signature <br /> Date (Revised 10/12./2015) <br />