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004P— ELECTRICAL PERMIT APPLICATION <br /> ;$44 <br /> PPL CATION► .; CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everettepsceverettwa.gov I lwm.even3ftwa.govipenvits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2.2401 1tti/ 'IY\'i fi cif SV&YE tt 11/JA of02.01 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED'dSFR-ATTACHED Cl DUPLEX ©'MULTI-FAMILY-#OF UNITS: C COMMERCIAL <br /> USE OF BUILDING I Vi I (JI <br /> ELECTRICAL.APPUS ATION INFORMATION <br /> CONTRACT PRICE OF WORK:S cb <br /> NUMBER OF DEVICES(if low voltage) <br /> FIRE ALARM? ID YES LUNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: WO OlI tucir 1r t Q <br /> CONTACT INFORMATION <br /> OWNER NAME: mail itoter TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2201 V'' I i At (rt <br /> c,,, Y STATE Itifi afle I:: <br /> OWNER PHONE:(42 )&1-1C 2.1 OWNER EMAIL: N f A <br /> CONTRACTOR NAME:In House Electrical Services, Inc. <br /> CONTRACTOR ADDRESS: STREET 1530 117th DR SE <br /> «y Lake Stevens ,TATE WA xe> 98203 <br /> CONTRACTOR PHONE:425-760{3203 'CONTRACTOR EMAIL: iheperrnitS@grnail.c om <br /> CONTRACTOR UC.$(REQUIRED inhoues952qg (CITY OF EVERETT BUSINESS UC.#(REQUIRED):044168 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-760-3203: <br /> Kelsey CONTACT EMAIL:ihepetmits©gmailcom <br /> AGREEMENT:Ihereby certify drat I hew read and examined:this app ton and know the sabre to t true end coned ANprovisions of laws and ordinances governing this type <br /> of so*MV be completed whether speared herein or not The panting of a parrrtitdoes not presume to gam authority to vlotate or cosset the;provisions of aryr rerste or <br /> local raw regulating construction or The perfonnanatof mon. Thal t.an twthorizedbyPre owner ofthis property to perform the:won r for which aPPiteation matte end l- <br /> oorr4oPy with the State Contractors Law 18.27 RCWand 298.200 WAG. <br /> C I Of Everett Official Use <br /> Only <br /> / IF <br /> 1 PERMrT <br /> '1m ,.. 4/3o .f E �gOL — 2. 10 <br /> Ownrl >xlp tstftra Data (Revised av23v2O16) <br /> Scanned with CamScanner <br />