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W 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 1 (E)everetteps©everettwa,gov I www.everettwa.goviperrnits <br /> PROJECT ADDRESS: 41117e 110 Jo - <br /> s <br /> BUILDING AREA(Ir residential,new construction,remodel,oraddition) <br /> SF <br /> BUILDING TYPE: 0 SFR-DETACHED ©SFR-ATTACHED t o <br /> HED ©17J, t X 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ° .. .° fir, ' � <br /> CONTRACTON <br /> •'.� <br /> PRICE OF WORK: $, <br /> NUMBER OF DEVICES(If low v0409011; ..: <br /> FIRE ALARM? ❑YES <br /> 0N <br /> ASSOCIATED BUILDING PERMIT#(If erpilble <br /> 4,, 6), it ‘ , <br /> #gr <br /> OWNER NAME: ,. '. <br /> ' <br /> _, ~� A on TENANT NAME(If'Commgrf fal : <br /> OWNER MAILING ADDRESS; srrt6E_r <br /> otjY <br /> .ad 0 e 3iukr `` <br /> OWNER PHONE: <br /> OWNER EMAIL: <br /> CDN'TRA TOR NAME. i'?. " <br /> C;t.Nt`TRA.CTT'Olt ADDRESS: s1REFr <br /> CONTRACTOR PHONE "i ° sT 4 41 41 207 <br /> 4a5-07/5q : CONTRACTOR EMAtJ.> < r „ <br /> w e, "iC' •+� .�;;" RE:O'i1IR :fBtla'" r � �l'. F,���+rt -:i4� � 4 <br /> PRIMARY CONTACT: -.. C `t�E1�' �"'BUSlNESS t,IC. ' �tUfl� _" <br /> 0 OWNER F =CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:> <br /> CONTACT PHONE: <br /> 1 0 0 • ie CONTACT EMAIL ,, <br /> AGREEMENT:I hereby certify that have. read and examined this application and know the same to true and correct. Al provisions of laws andordif ordinances goveminthis t e <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate orcancel the provisions of any other stagte 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 Iyp <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC. <br /> City of Everett Ofclel.Use Only <br /> PERMIT# <br /> er} uthorlae 1 Agent Signature E �O� O / <br /> Dale (Revised 9/23!201(3) '' <br />