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grr ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: l'4/1 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ J .. 63v4 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 'NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: j(,$',02 ruk.1J: ‘44/-1-{,e..-,--; 0- f"11( . c f.4 <br /> CONTACT INFORMATION <br /> OWNER NAME: t• A tow-' Lp221.:Cia} ;`I t / TENANT <br /> �NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 344 l-c14.�{/-/0 rv6.- y� <br /> CITY L; eSTATE Ut'"'yy• '- ZIP q !fw"/, <br /> ` <br /> OWNER PHONE: gbo 5-6,5 6 ( /OWNER EMAIL: rz�(.�,•Zi'. }(,,„,x '(G 01.5.;/11-14-e/ G'ch.-- <br /> CONTRACTOR NAME: (may/ %( i ) ]"'�i i IJTyd-,--e- — <br /> CONTRACTOR ADDRESS: STREET `2-1.2..(1) G_& ( i.. <br /> CITY t STATE L-J zIP4 f7 6..��`i <br /> CONTRACTOR PHONEk4 ) y2. ((t.,�- CONTRACTOR�� EMAIL: ( ' <br /> CONTRACTOR LIC.#(REQUIRED):Br e-.5- e. ep CITY OF EVERETT BUSINESS LIC.#(REQUIRED): c <br /> ,�c <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT.NAME: CONTACT PHONE: (L j-•�1 �� Zv 3//9 <br /> CONTACT EMAIL: vkLf S n'LLt)a, G,01.4t. <br /> AGREEMENT:I 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 lam 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 298.200 WAC, <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ✓a E lbob —/V3�1 <br /> Owner/Authori ed Agent Signature Date (Revised 9/23/2016) <br />