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,a-- ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-88574(E)eV ' r +e ttv+t P tllit ....:. <br /> PR 4ECt I€` I-CON <br /> PROJECT ADDRESS: , r <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SP <br /> BUILDING TYPE: ►: SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS': 0 COMMERCIAL <br /> USE OF BUILDING: <br /> Otit104 77410A601 *.r <br /> CONTRACT PRICE OF WORK: $ ( c° <br /> NUMBER OF,DEVICES If low volt. <br /> FIRE ALARM? 0 YES 0 <br /> ASSOCIATED BUILDING PERMIT# if a ti ble <br /> �xW DESCRIP.TION.O.FWORK.....:.... .moi :_ a .. <br /> L.0 Minlier0• <br /> OWNER NAME: dtritta Ar` <br /> �f. . . -• � TENANT NAM (If Comoorate!): <br /> OWNER MAILING ADDRESS, STREET , !r <br /> crrfSTATE ZIP �. . <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Ali <br /> CONTRACTOR ADDRESS: STREET Li 1$.Nalb k4„,.Ctn <br /> CITY .: _.,.,`, ' STATE Mi ^ ZIP ` t <br /> CONTRACTOR PHONE: • C If d>,' CONTRACTOR EMAIL: d F e 9 114 <br /> ar <br /> TRA TOR"t: ,:#tRE E t <br /> �"'I�7� " a'C._..•..'. CITE'OF EVERETT BUSINESS LIC ~I_Oi1tRE0, 11, r ,lr <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CAW L. <br /> CONTACT EMAILst. �, til CO <br /> rb <br /> AGREEMENT:I hereby certify that i have read and examined this application and know the same to be true end 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 stale or <br /> local law regulating construction or the performance of construction. That!am authorized by the owner of(his property to perform the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> w ?Lig E 01 — 052 <br /> twnar(Auth•rized Agent Signature Date <br /> (Rev/sed 9/23/2018) <br />