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0 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 vwvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION _ <br /> PROJECT ADDRESS: 7'(75- Y"(V x c c /( or w re ,3J - 77(i-, <br /> BUILDING AREA(ifr ide iai,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> Mt . <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: l (plG{a_1//C) saL pane( th £1 Ct rCl e_. <br /> CONTACT INFORMATION. - <br /> OWNER NAME: 0v(1 I YS t7pr"At Y'v AYE TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 71/ ?S 144eDt) 4'// 1W gs2„02 <br /> J <br /> CflY CL/P Cc" if STATE( STATE IJ)/1— III <br /> ZIP <br /> OWNER PHONE: 6-P 9Q (7513 OWNER EMAIL: �S )3V�A 3t/Q( 141,01 I4„�,/4 V' J+ 1 <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: Er OWNER ' 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N�(AMME: �� CONTACT PHONE: 1.,7S 703 6S 3 <br /> O1it.<t,S 4" CONTACT EMAIL: <br /> AGREEMENT.-T hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this <br /> type 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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> / 7 PERMIT# <br /> Z g '/ E �/V i7/2_-a0.3 <br /> Owr orized Agent Signature Date (Revised 10/12/2015) <br />