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12/01/2017 09:46 #2973 P. 002/002 <br /> 477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-2578857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION • <br /> PROJECT ADDRESS: ii,241.4. 411 <br /> tr,la(i% O <br /> BUILDING AREA Of residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: !a SFR-DETACHED 1J SFR-ATTACHED- 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: __ ❑COMMERCIAL <br /> USE OF BUILDING: u//YaI.CAC/AL <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 a••licable : _ <br /> t�- <br /> DESCRIPTION OF WORK: ILFPAf1L g.Eetr9-ti gO/Wr A 1 <br /> / <br /> CONTACT INFORMATION ter+ <br /> OWNER NAME= C(' LE TENANT NAME(If CornmerciajJ)If[&#49 1` Jt. <br /> OWNER MAILING ADDRESS: S7P82T �VZ •,fit,' .1 -)6(0ITY - f 1 <br /> OWNER PHONE: .Ag 0 (� OWNER EMAIL: <br /> CONTRACTOR NAME: 1 ' //Z . : / - ,' I. <br /> CONTRACTOR ADDRESS: SIREET /� a • A. J/1I _ _�(q/f} <br /> II CITY f_w 1T -• _ STATE�" ZfP 7rie <br /> CONTRACTOR PHONE: WS �t CONTRACTOR EMAIL: } <br /> CONTRACTOR LIC.#(REQUIRED): *L.tk�W / '. _ CITY OF EVERETT BUSINESS LIC.#(REQUIRED:6/ ?. <br /> PRIMARY CONTACT: la OWNER . CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 5/J ' 0.23/ <br /> D D tt GiA CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that!have read and examined this application and know the same to be true and correct Allprovlslona 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 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 206.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E V HZ - oocf <br /> owner/A 'ized Agent Signature sate (Revised 9/23/2018) <br />