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OLTr 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 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 26 CI �I�(rJCa2,...... -T"--•- it <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ID DUPLEX ❑MULTI-FAMILY-#OF UNITS: ID COMMERCIAL <br /> USE OF BUILDING: • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ j <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 't5ic o ��� V C i Ji OKRA-17-4-461 AI)6 R <br /> ,u'l410 1.ltJL1' / <br /> . CONTACT INFORMATION <br /> OWNER NAME: Rj 0 A11004<c-iv TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 240 2—,�'�-0(G&2&Z zY-�4sJ ^ �^ <br /> CRY E1Ger STATE 1{,/4 - ZIP WOO <br /> OWNER PHONON . 7- 'W/fc OWNER EMAIL: b &J t r tv4hw(O l tG�51:i9ef <br /> CONTRACTOR NAME: t c — 1-!lam-- 'If.eA(it <br /> �/ <br /> CONTRACTOR ADDRESS: STREET 1.J1 GoC.170 (tet.- (C.. rr ' (�� <br /> CITY L..n STATE U.../C÷ <br /> � ZIP 7(trz <br /> CONTRACTOR PHONE0./Z0 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): / ,, 5• Z (2.A.)) CITY OF EVERETT BUSINESS LIC.#(REQUIRED):{;6"7c(cc <br /> PRIMARY CONTACT: El OWNER ILaCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: l.F ZZ r 2_5'2_-3//4/4- <br /> e--, <br /> '- <br /> e- Lc) CONTACT EMAIL: gii &5,571,7 (,t" s YYyyyt <br /> AGREEMENT:I hereby certify that!have read and examined this 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 I 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � - :1 1 — E1Q <-- 12)0\ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />