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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 1 www.everettwa.gov/permits . <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: G 7ft:Ai,/ I.4v /l <br /> BUILDING AREA(if sidenti new construction,remodel,or addition) i i CIVSF <br /> BUILDING TYPE: 0 S R-DETACHED SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION • <br /> CONTRACT PRICE OF WORK: $ ll °O <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES )(NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: el 4 4 1 0 teN1 IT <br /> CONTACT INFORMATION <br /> OWNER NAME: K <br /> ` JQ/)/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:Al(B EET 1°7 •Prl./✓ <br /> /414-1 <br /> - <br /> CITY `n�j ,j STATE ZIP f"V � <br /> OWNER PHONE: (#11.9' "01' I iii/',D OWNER EMAIL: K{/V 0)o 11� 1],0 10 l ; ,CO Wi f <br /> CONTRACTOR NAME: 1)611(c ✓1/Iftt/ f--Will-GI <br /> `I <br /> CONTRACTOR ADDRESS: STREET, ,aey7'° �/91+4101 ji'. v•f,. <br /> CITY VvV 1iV STATE4/100 1$74 i <br /> CONTRACTOR PHONE: Lt "/ • �l CONTRACTOR EMAIL: V f e/J�6/•(/O <br /> [ 404-, <br /> y p fNa <br /> CONTRACTOR LIC.#(REQUIRED): A K V U 4 CITY o EVERETT BUSINESS LIC.#(REQUIRED):1,711 frigl F17 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR )(OTHER(Please Specify) 6(0701 <br /> CO A T E: CONTACT PHONE: 1.-11.-• 2V. Ili Yu <br /> �f o" O 1j CONTACT EMAIL: I$4 i k a (•j) 8' c, . covviAGREEMENT:1 hereby certify that1 have read and examined this application and know the same t be hue and correctr' ' <br /> 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 1 am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the <br /> ��State Contractors Law 18.27-RCCW/and 296.200 WAC. <br /> P41) <br /> frf <br /> 11 hot� plvskv4wure'J <br /> willc. CES <br /> 141 <br /> City of Everett Official Use Only <br /> ,p - PERMIT# <br /> , , 10 . 1 . 1% E i ( O- tD ( <br /> Own rlAu horized Agent Ignatufe Date (Revised 9/23/2016) <br />