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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 /> OJECT`:sEff joN <br /> ��t <br /> PROJECT ADDRESS: �5 9 � + XVI v t c r V V <br /> BUILDING AREA(if residential,new construction,remodel,or addition) - SF <br /> BUILDING TYPE: FR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY #OF UNITS: ❑.._COMMERCIAL <br /> USE OF BUILDING: CS f ( <br /> �. , , :0X LCTRICLAPP ;' �„ eg (I * Mitn E , ; - <br /> • <br /> CONTRACT PRICE OF WORK.$__ <br /> NUMBER OF DEVICES(If low volta ): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT# :applicable) <br /> DESCRIPTION OF WORK: 200 Qtnp , fa-tt,G4 <br /> (& 1 " . u ra <br /> v <br /> a <br /> , CDNTAC'�`aiNFONllM '1O1t1 ," :, <br /> OWNER NAME: 141,I I/r*r' n�,r) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 i 4 ii, )avic r W " <br /> cirY ee YC fle 1 1 STATE 11 ZtP e6 . P. <br /> OWNER PHONEiff. 1 i9 OWNER EMAIL Tc)nil(, ... U f( ' # i" ,.cortel <br /> CONTRACTOR NAME: Sc.ct oton. c i 0 <br /> .. . <br /> CONTRACTOR ADDRESS: sTREET (31131 Cii QL C. <br /> crry e,ye re-4- _ STATE W' ZIP (/20' <br /> CONTRACTOR PHONE ZOCr 4051,43(1410 CONTRACTOR EMAIL:" &411fAn ` '')41* a • <br /> CONTRACTOR LIC.#(REQUIRED) ,SA ZJ(O r fa, CITY OF EVE BUSINESS LIC.#R••UIRED): _ <br /> PRIMARY CONTACT: 0 OWNERCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'ii)(p- !r 03-- 360 t <br /> Q,� ' CONTACT EMAIL: . Q Imo I' ,F. Sett <br /> " !C •C# <br /> AGREEMENT:I h y certify that I have read and examined this application and know the same to be true an..•. =ct. All provisions of laws and ordinances governing this type <br /> of work will be com ted 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 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> gX 4t PERMIT# //�/ <br /> • tlnv 1tI ) E ) OCA °1 <br /> Owner! uthorl .Ift•gent Signature Date (Revised 9/29/2016) <br /> 1ff <br />