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ELECTRICAL PERMIT APPLICATION <br /> -3.- 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(dieverettwa gov( vvww.everettwagoWpermjts <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 73 € <br /> BUILDING AREA(if residential,new construction,remodel,or addttion)___If 4100. SF <br /> BUILDING TYPE: 0 SFR-DETACHED. SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICALAPPLICATION,INFORMATION <br /> CONTRACT PRICE OF WORK:$ 910 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES -IaNO <br /> ASSOCIATED BUILDING PERMIT#Of applicable): <br /> DESCRIPTION OF WORK: ..gyp . 1 ' .c t <br /> CoNTACT=:.INFoR <br /> OWNER NAME: .1t"0*, . $�f;`c��+�,TIIAME; Li <br /> OWNER MAILING ADDRESS: srnEeT „ <br /> CITY 440,0� .. STATE ZIP 97,x.7 <br /> OWNER PHONE: 910 le 3 OWNER EMAIL: tii f:•a <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC,#(REQUIRED)a CITY OF EVERETT BUSINESS UC.#(REQUIRED) <br /> PRIMARY CONTACT' OWNER Q CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: A CONTACT PHONE: 9 <br /> CONTACT EMAIL: 1+ peQ <br /> ALJ <br /> AC IEEMENr I hereby certify that t have readand examined this application and know the same to.be true and correct. MI proviskms of laws and meinandea governing this t e <br /> of work will be completed whether>secified Promisor not. The granting of a permit does not presume togive Whorl*to vete Or cancel the provisions of any other state or <br /> kcal law regulating construction or the performance of COnStreChMt. That am authorized by the owner of this propertyto perform the work for which application is made and t <br /> comity With the State Contractors Law 18.27RCWand 29 100 WAC. <br /> City of Everett Official Use.Baty <br /> PERMIT# <br /> 0 . Z /9 E m(0 <br /> Owner/Authorized Agent "•nature bate (Revised 0i 3{2016)' <br />