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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 /> 41 <br /> PROJECT ADDRESS: <br /> (f $.. 2, r• cS? tiff.r '+ A ? ' d <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED El SFR-ATTACHED 0 DUPLEX El MULTI-FAMILY-#OF UNITS:, 0 COMMERCIAL <br /> USE OF BUILDING: t ; t <br /> "V‘ <br /> ION <br /> ice. - w � � . . � � .. _. �.. - -,., .ti <br /> CONTRACT PRICE OF WORK.$ •1 <br /> ,x, f <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: x;45 i 0 _ <br /> CONTACT INFORMATION ... <br /> ` e <br /> OWNER NAME l -1'6 ril. <br /> 1 TENANT NAME(If Commercial): <br /> '- OWNERMAILINGADDRESS: sTREEr x,21 " , ,,,r <br /> CRY Nt`\G STATE 'A zip 20° . <br /> OWNER PHONEHZ ' O-' 92'1 OWNER EMNL: �An ' �� " f1.0 <br /> CONTRACTOR NAME (-4 t <br /> f'1 `ei) 1 r • <br /> CONTRACTOR ADDRESS: STREET .` a , .... r o Q <br /> ;; ,ear <br /> CRY �e�f.. STATE INA ._ 21p <br /> CONTRACTOR PHONE: 2O(0- 905.3Co 90 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED; ,seIST°EQ ?)(OO : , CITY OF EVERETT BUSINESS LIC.#(REQUIRED) <br /> PRIMARY CONTACT: ❑OWNER P CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (0 - q 0.1 - CP 901 <br /> Ma CONTACT EMAIL <br /> it ''� d ._._ <br /> fa <br /> AGREEMENT:I ti-,.y certify that 1 have read and examined this application and know the same to be true and ., provisions of laws and ordinances governing this type <br /> of work will be co ,.eted whether specified herein or not. The granting of a permit does not presume to give a ; 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 /> City of Everett Official Use Only <br /> PERMIT# <br /> E '''' ,D In* 0 ic,3 <br /> • ..,Authors .ent Signature Date (Revised 9/23/2016) <br />