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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: (qa,..5C,Q>4,d A-1---__R
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:''Re... t5) ,„���^1,, 1
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK: $ 7 C �
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES kNO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: '�'a✓.--- ,,,,22_,- ceA_A LL°.9-., , .,. g/1> A
<br /> 14,1
<br /> l 7 e O rte/
<br /> CONTACT INFORMATION
<br /> OWNER NAME: A/U/,,(% r( eSS-)h �, TEN NT NAME(If Commercial):
<br /> OWNER MAILING ADDRESt STREET t Q,0�
<br /> 1/((( '
<br /> CITY €fff"'2-J STATE 1.,(....b/ ZIP
<br /> OWNER PHONE:(9.,0•6, 7 7 /,-);,..,--5, OWNER EMAIL:
<br /> CONTRACTOR NAME: SI A "i I—l` .e `/,
<br /> CONTRACTOR ADDRESS: `STREET ,4,4 / 6,1,,,,,..."5.t.4/1.) .
<br /> CIT -.--'Ql✓101 11 STATE IdLX-4
<br /> ZIP F5T2 OP�
<br /> CONTRACTOR PHONE:' ) 1 3"7 J j C,� CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED):iJ/l ff-Fa2 Cr574 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)dCi .7 3l(
<br /> PRIMARY ONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONT NAME: CONTACT PHONE: -54c) 3$ 7 //C .
<br /> J CONTACT EMAIL: `5 ,/ 4,,,,f7
<br /> AGREEMENT I hereby certify that I have read and examined this application and know the same to be true 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 --1C11,
<br /> Own- •uthorized A.• t Signature Date (Revisred 9723%2016)
<br />
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