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4terr 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: tI-24 1kON ( k <br /> BUILDING AREA(if re ' ential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: LJ-SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: e pk Nii,S13.kik <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? D YES D NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: '41 Yep1.o ce <br /> 6 <br /> CONTACT INFORMATION <br /> OWNER NAME: F % &tJ4 5NJ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f,1A-2 *0-1 <br /> "1 k\/ E (/� `-7� <br /> CITY ) t, ` STATE\NA- ZIP G'V <br /> OWNER PHONE: 62�-. Cj'J OWNER EMAIL: N.)(&" <br /> CONTRACTOR NAME: k L b *- c„ I.l\kb 'NV' 2) _+i. � �. L 1,K1.c,rr <br /> CONTRACTOR ADDRESS: STREET \\pC7 ` tj\� 5 'Q- c P ) 1 VE <br /> CITY y.-A, i��J STATE WP ZIP CigY3-)2 <br /> CONTRACTOR PHONE:AJ `'( ' t -1 -& CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQQUIRED): jV-U 9A6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5 <br /> PRIMARY CONTACT: ,❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:.42_6 - -04L ,L4 <br /> C,e,n a•A <br /> CONTACT EMAIL: �., �_•_:!'_.=—'�.. .'>�� <br /> AGREEMENT*I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws an'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 pr.visions 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 hich 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 /> /-441111PERMIT# <br /> Ait.= ig A I • E <br /> er/Author A ature Date (Revised 9/23/2016) <br />