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„,.�,--A 111IP - 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.govfpermits <br /> z'Pt EC;'t"Is111'eNP,,. <br /> PROJECT ADDRESS, op,. er wlJe,— <br /> BUILDING AREA cif residential,new construction,remodel,or addition} SF <br /> BUILDING TYPE SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING; <br /> ::=!;:;::'''''„11,k-' <br /> '''''.-!'tadtFtitiAleY"AV•POOkill # _ <br /> ht <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES :`low vottSe.: <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if'applIcable) <br /> te ',,C ,, , VO <br /> a . �„ <br /> (41 . y4ealiv-4 now-lei. <br /> k‘ <br /> OWNER NAME. Lir s TENANT NAME If Commercial, <br /> OWNER MAILING ADDRESS: slater <br /> 40 1 <br /> Cn'1( 104.....C o ... - STATE A' ZIP ' <br /> OVVN i PHONE: 1 OWNER EMAIL:. <br /> CONTRACTOR NAME: A '.-. ” <br /> ti <br /> CONTRACTOR ADDRESS: srnE_T I{ I <br /> 'ate . <br /> CITY � s q <br /> ...Amok. STATE • A ZIP t <br /> CONTRACTOR PHONE: <br /> f,,16 ,aa *740, e`= ,co TRACG-ToFtEMAIL: .. '.. d'." 1N 1.# et.. r 4 <br /> e' _�°- D)3?.IC. '�?E'Q'Ulk�i:@t7)t 4. '. iF• . v � , ,® <br /> JTY OF EVERETT BUSINESS LIC71 <br /> PRIMARY CONTACT: 0 OWNER rA CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 0 4 4 ie CONTACT EMAIL: 0 , ' <br /> AGREEMENT:I hereby certify that'have read and examined this application and know the same to be true nd correct. All provisionss lawen�it nances 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 stale 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 end 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 /> - if .. -\Q.�k AftE <br /> fSa �t{urtittlr#xd`Agent Signature 1 lY $ 1 <br /> Date (Revised 9/23/2016) <br />