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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: j3,,, W e511 1C re- <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: /QFRDETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL''APPLUCATIoN'INFORMATION <br /> CONTRACT PRICE OF WORK:$ 250 ,«> <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: IncinAAc ci-1 es lurid- <br /> CONTACT INFORMATION <br /> OWNER NAME: . t . .: . .- <br /> Tdxei 1'1G1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET :7102,3 Wetmore_ <br /> fE- <br /> cnv ede .Yr l _ STATE 1,43 A- ZIRgL.0 I <br /> OWNER PHONE: 142,5 -"7G'I --zgos 'OWNER EMAIL: <br /> CONTRACTOR NAME: "t <br /> CONTRACTOR ADDRESS: STREET ( p Li rs Wo L,�y�Q, ` - ' ,may <br /> cny (e,ti eRe '"(,�+r';.w`1 STATE 1A/ ZIP.q5 20 1. <br /> CONTRACTOR PHONE: 11a5q b (CONTRACTOR EMAIL; de b e CJ C'/S�v� l 4-id- j , +) <br /> CONTRACTOR LIC.#(REQUIRED):CYY1i t2.(Wn i%— - CI JCITY OF EVERETT BUSINESS LIC,#(REQUIRED): I too <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 1--fQsa5aa <br /> Wale Ie CONTACT EMAIL: deb 3( ( aii ,corn <br /> AGREEMENT:I hereby certify that(have read and examined this application and know the same to be true and correct. All provisions of/avis 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!am 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 /> P€12/24'_ <br /> PERMIT <br /> :City 5 10.25.! 7 E (0 - 2 c5 <br /> Owner/Authorized Agent Signature <br /> Date (Revised 9/23/2016) <br />