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- 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: 7 1 1 vGKt9 `s y,Q <br /> BUILDING AREA(if residential,new construction,remodel,or addition) t`'' 3•-g00 SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ --ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRI•AL APPLICATION INFORMATION <br /> CONTRACT PRICE <br /> OF WORK: 3 3�q gif <br /> NUMBER OF DEVICES if low v•lta•e : <br /> FIRE ALARM? 0 YES 0 N! <br /> ASSOCIATED BUILDING PERM # i�;l1•Iicable,: <br /> DESCRIPTION OF WORK: 1Qt (47 i,-e t.'S: ' <br /> CONTACT INFORMATION <br /> OWNER NAME: ICC.r a - L-3cc.5o TENANT NAME If Commercial: <br /> OWNER MAILING ADDRESS: sTr a r -?( 1 Roc ke.rL ,/ - <br /> .: .. CITY E Va arta ._. STATE • ZIP `f 2-.2.0/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NE: 1 ? /_ 'c ` <br /> CONTRACTOR ADDRESS; STREET 13 ,. ('' la.s 0., <br /> CITY:::. &oIA ...- STATE ".d se ZIP a <br /> CONTRACTOR PHONE: - , 1 ° ' +i ° a Q CONTRACTOR EMAIL: 'r M"' A i s`. ; 0� <br /> CONTRACTOR LIC.#REQUIRED): r cy : I Q" .,t) - CITY OF EVERETT BUSINESS LIC.#REQUIRE.r: ., 1;• . <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify),,, 1111., <br /> CONTACT NAME: CONTACT PHONE: 3 6 0 9 Y/ - 5 3 R ' <br /> drewl ;f tti <br /> CONTACT EMAIL: <br /> AGREEMENT:l hereby certify that I have read and examined this application.and know the same to be true and correct. All provisions of laws end 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 296200 WAC. <br /> City of Everett Official Use Only <br /> 411101, <br /> PERMIT# <br /> I � IS i� E 1,,,(- 2 - 120 <br /> awner/Authorized Agent Signature Date (Revised 9/23/2018) <br />