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‘ 71'77- ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-B810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov ( www.everettwa.gov/permits <br /> PROJECT:S1TE;INFiAti i4 1QN <br /> PROJECT ADDRESS: 12230 1q44' ?, LSE 416E) <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 /> ELEdt t1C ,d ;1 :6 ;` 06, 0P; [ M " t 141 <br /> CONTRACT PRICE OF WORK: $ O ,o0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES XNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable); <br /> DES_CR1P_T1QN.QE_WORKL._, _. <br /> OWNER NAME: 'Gt,Y1C..1 S,c4k, aitscein , � -�{-G, <br /> TENANT NAME(If Commercial): <br /> ■1 <br /> OWNER MAILING ADDRESS: STREET 1220 tc - 44-e> <br /> CITY sF'-"r"f STATE W ZIR Cie 20eOWNER PHONE: 425 t 7 �1 OWNER EMAIL: <br /> CONTRACTOR NAME: CXYl G <br /> CONTRACTOR ADDRESS: STREET p L'C�`1 I'S' 13(0CIry t,.C...�('�,.7zt/ti,J - STATE , - ZIP 93 20 1 4: <br /> CONTRACTOR PHONE: S CONTRACTOR EMAIL: <br /> rvi <br /> _. -o-m-R Torf-LTC:-#(REfUiRED):t, YA <br /> ----- CITY OF EVERETT BUSINESS LIC.#(REQUIREDj: ti,(-)C1.2) <br /> PRIMARY CONTACT: ❑OWNER laCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ��(�,�-yy CONTACT PHONE: 1- ^ 350,1 D <br /> 'JoJUto CONTACT EMAIL: debIZ (3 vicar) CQY'r) <br /> AGREEMENT:I hereby certify that(have reed and examined this application and know the same to be(rue and correct. All provisions of laws and ordinances governing(his 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 lam authorized by the owner of this property to perform the work for which application Is made and 1 <br /> comply with(he State Contractors Law 15.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> peb 5 (a cts. t cs" <br /> E (?.\ -C92_ <br /> Owner/Authorized Agent Stgnatura <br /> Dale (Revised 9/23/2016) <br />