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ELECTRICAL PERMIT AI ICATION <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 INFORMATION <br /> _ <br /> PROJECT ADDRESS: R ,?�� $i--a <br /> BUILDING AREA(if residential,new construction,remodel,or addition) \ C59 SF - <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> i4.......V..._L <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES )NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: (l '_ .j FA jkk.gc) <br /> f'cicldfs < --Ls7L f '(it&:,---C__- <br /> CONTACT INFORMATION <br /> OWNER NAME: \ -qr. ,......_17...„NI ` TENANT NAM (If Commercial): - <br /> OWNER MAILING ADDRESS: STREET \r \ 1 �� , 12... .... <br /> ' <br /> e <br /> rr( <br /> C\ `�\1k \ `' STATE C IA` ZIP (�`(, pd �'. <br /> OWNER PHONE: q2.5^��3��,..zi6 Z OWNER EMAIL: `. , ,. <br /> CONTRACTOR NAME: G t'Y"' ` <br /> CONTRACTOR ADDRESS: STREET J <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: [ WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: . \ \ CONTACT PHONE: -L¢ 2 5 ' >39,- ,` t` >4-1\)\ CONTACT EMAIL: { <br /> i>, <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions oflaws 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> • <br /> iSOo2 <br /> .41111P Je ' t PERMIT# <br /> i t, ,c/C / <br /> c... ' ,.. \7 E 1805-(40 <br /> v <br /> Owner/Authorize Agent Signature ` Date (Revised 90/92/2095) <br />