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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everetlwa.gov www.everettwa.gov/permits <br /> PROJECT 8IT :TNPORl' MTiO N <br /> PROJECT ADDRESS: `t'g 35 1..A.-.?..<5+- 1.-eA f'1G,.,,en Lr" <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: + 'FR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> EL;EttftiCA 1e lbi re;010ORM AtION <br /> CONTRACT PRICE OF WORK: $ 2-50 ,o0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# i a Ilcable <br /> .DESCEJETIO.N_OE_WORK:__ ' �► R iso :�► �. t .1 «�. <br /> 1111 <br /> 1 l lt3 �. TENANT <br /> e NAM ( C <br /> OWNER NAME NANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: TREET <6421 t.- `5 rd Ave, <br /> e/T> V e ftantet>e STAlE W z!p ciTtp g <br /> OWNER PHONE:420 3g7 067 OWNER EMAIL: <br /> CONTRACTOR NAME: Crn. 0,9--a-11J <br /> CONTRACTOR ADDRESS: STREETt�� ! I O'()����y} <br /> trTr P-Sia- el tr` STATE SR ci 1 0 <br /> CONTRACTOR PHONE: `j 3 OCHO CONTRACTOR EMAIL: • Aka f <br /> oNTRAC I OR L1 #{RE'c uIRIMup, h __..... E.__ <br /> ,. � �� __. CITY OF EVERETT BUSINESS LIC..#(REgUIREDT Ic�`L12 (2) <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: } CONTACT PHONE; --RiS 35q 0,T-03 <br /> 'ekkie <br /> CONTACT EMAIL:.de1615t (� �•G� •corn <br /> AGREEMENT:I hereby certify that I have read and examined(his application and know the same to be true and 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 state or <br /> local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform(ha work for which application Is made end i <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Pebb-4-- cuttp.../t) <br /> 5• R•l 8 E <br /> Owner/Authorized Agent Signature <br /> Cale (Revised 9/23/2018) <br />