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016:51'47-T 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.gov/permits <br /> PROJECT,SITE;INFcORMATION <br /> , <br /> PROJECT ADDRESS: 23 i Ck etate,s5A <br /> BUILDING AREA(if residential,new construction, remodel,or addition) <br /> SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> "_ ELECTRICAL APPLICA'rt©N?°INJORMA'tION <br /> CONTRACT PRICE OF WORK: $ j .c)° <br /> NUMBER OF DEVICES if low volta e : <br /> ;FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCR1PTIONJDEWORK.._ .....__ <br /> O , 2— 2Gc.A.;V'.S 1'Z.l-- h <br /> ;d04 AC'1`ILII ORM;ATiO <br /> OWNER NAME: w.Q�r VIA,00kvatAl, TENANT NAME(IfCommercial : <br /> OWNER MAILING ADDRESS: STREET 9.3 c 4q b&tit c Me, <br /> S Y 4krer1 . STATE____l .A,- zpi L..( <br /> OWNER PHONE: ' ,Lj� OWNER EMAIL: <br /> CONTRACTOR NAME: KO-C.A_1111C <br /> c <br /> CONTRACTOR ADDRESS: STREET lr I"`1 15 WO <br /> i CITY "✓.r„".`e-R 1.../L STATE A- ZIP Ci3 20 1 <br /> CONTRACTOR PHONE: , ,tfi„q r" * CONTRACTOR EMAIL: a •.i ,a . 4gj 1° <br /> "�NTRi�CTtSR-C1C�tR.QUI� etEq %.1'?'thE4,, � • � � tM <br /> ) i 1��-Pj — CITY OF EVERETT BUSINESS LIC.#(REQUIRED. 2 <br /> PRIMARY CONTACT: 0 OWNER ri CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 1 <br /> �� n CONTACT PHONE: L--f 5 3541 O <br /> Le CONTACT �,.,EMAIL: (�� <br /> AGREEMENT.!hereby certify that!have read and examined this application and know the same to be ry end Corrt. A!Ilsrlo corn <br /> d ordinances governing t <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give euthorfly to violate or cancel the provisions of any other stalehis <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 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 /> �— 'a 2 . SO" cCh E ,E1 - 02 . <br /> Owner/Authorized Agent Signature <br /> Date <br /> (Revised 9/23/2016) <br />