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• <br /> Orerr 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 INFORMATION <br /> PROJECT ADDRESS: ,,T1 /-/,C /acv_) Ed <br /> . <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ft-SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /Cj7 e CTJ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? D YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ��(�(t(�f 1�(Zi RGt`. Pc 2lL._ 10W <br /> i1.1r-0 <br /> • <br /> • CONTACT INFORMATION • <br /> //ii <br /> OWNER NAME: til i\,t5'1`I t..a A Kt.L�..,AA-p,,, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S' V 3 1-4/6/11d4t..9b K ��jj���� <br /> CITY (.:�(� �"�- STATE LOA , zrr 229 3 <br /> OWNER PHONE(0_O6) go, _ Lac(c--41OWNER EMAIL: <br /> CONTRACTOR NAME: t3' - J cf --re-. l4 C ' A(.! <br /> CONTRACTOR ADDRESS: STREET' 2.I Z O / <br /> CITY aieZec) STATE WA ZIP 91 <br /> CONTRACTOR PHONE(417.0 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):,f1 ,SS Z RA) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ,7c 55- <br /> y. „ n. <br /> PRIMARY CONTACT: i3 OWNER ffCONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: k Z52 _ /t� <br /> A io CONTACT EMAIL: I.�� d75,571,7 Iva.zrom <br /> AGREEMENT:1 hereby certify that I have read and examined this application and know the same to be true and correct. Ali 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 1 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 78.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> "Z E (60_, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />