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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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> A/4 <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: (G'2 <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 7c <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES UcZNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 41.4/2../ t:3 f5 f-fe-1 —r Pu i) <br /> CONTACT INFORMATION <br /> OWNER NAME: O/74/( 4' y /14,04.4— TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6 23 /4.1A-,2,27u /4 /� �C-F J J , <br /> CRY tJC''Lly(�- STATE ti( ZIP 3 <br /> OWNER PHONE:( J 2 2. — /q J/ OWNER EMAIL: Ai <br /> CONTRACTOR NAME: a/e `J�� .�.J(� /111-7-4 Cr <br /> CONTRACTOR ADDRESS: STREET 01.70 ✓¢CL G <br /> CITY STATE 1.44A ZIP 9 Z0 <br /> CONTRACTOR MONO) Z57-3//9 CONTRACTOR EMAIL: KG.I-L((p <br /> CONTRACTOR LIC.#(REQUIRED):�ti 5�lEJ ! CITY OF EVERETT BUSINESS LIC.#(REQUIRED)1. <br /> PRIMARY CONTACT: 0 OWNER M-€ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE(4i; OS <br /> (rte CONTACT EMAIL: t ,eS`S i4i4-fq .LtGG,-t. <br /> AGREEMENT:i hereby certify that t 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 tam authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> .e144 <br /> - �� EltbO0,' G613 <br /> Owner/Author ed Agent Signature Date (Revised 9/23/2016) <br />