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41677 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> I <br /> PROJECT ADDRESS: 1 V V -****-1-.1•44012.- <br /> '/1i�� <br /> BUILDING AREA(i residential,new construction,remodel,or addition) 1."—�. 0 7 SF <br /> BUILDING TYPE: J 4FR-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:$ <br /> NUMBER OF DEVICES(if low voltage): .d <br /> FIRE ALARM? 0 YES )21140 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ff'1 trz • t �� Ger,is,11,4 j <br /> GC;f1.--tra.A. C.r2- <br /> "TC, <br /> CONTACT INFORMATION <br /> OWNER NAME: Y t7 47tV' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE, ZIP 2-4E)J <br /> OWNER PHONE4 4* C OYj4 OWNER EMAIL: <br /> CONTRACTOR NAME: : / J 42.- 1 S GG 1 71— <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): )3; :)THER <br /> CITY OF EVERETT BUSINESS LIC.#(RE UIRED): <br /> PRIMARY CONTACT: WNER ❑CONTRACTOR (Please Specify) Atte-....4-4•{ e-'T <br /> CONTACT NAME: '' }} CONTACT PHONE:.4 <br /> 6 � �4- 1 CONTACT EMAIL.11- :c17 f e,L {L.° Z l'1e) <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type 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 /> �-f City of Everett Official Use Only <br /> FEE <br /> I /7 \\ PERMIT# <br /> ink og - ��1 E \c,O �- OS <br /> Owner/A 1' /l ent Signature Date <br /> (Revised 10/12/2015) <br />