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OLT ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ORIGINAL <br /> 3200 CEDAR STREET, EVERETT, WA 98201 D <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwagov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: \71_l'7 ') 'j J-1-- /Y�� L$C <br /> BUILDING AREA(if residential, new construction, remodel, or addition) r f{ k/77/71 SF <br /> BUILDING TYPE:8cR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ (Z1) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if a plicable): ` <br /> DESCRIPTION OF WORK: M ` ci rW I t TrN ' - / i(ofail _— <br /> CONTACT INFORMATION <br /> OWNER NAME: A ^ _l/1,U 1 ( jYi bi)�)JJ� TENANT NAME(If Commercial):----- <br /> OWNER MAILING ADbRESS: STREET 1Zi'1V) IA �e J V88 <br /> -/-- <br /> CITY c.�.eV.g- STATE ! ZIPI � '' i/ <br /> OWNER PHONE: �1-2�1– 31�� OWNER EMAIL: Pr HkVI(2 a 40___4')L ,Can <br /> CONTRACTOR NAME: 1"c)JI (J r V1 � <br /> CONTRACTOR ADDRESS: STREET-1\A( "7,Z0-111 (9t S.1, ) I <br /> M CITY , ? I STATE' ZIP <br /> IIg8 (� <br /> CONTRACTOR PHONE: v -'11 \ t-----/ 31 ,(f CONTRACTOR EMAIL:.,(�'�(1� � u-e- IO 6(7-r o' ,e, <br /> CONTRACTOR LIC.#(REQUIRED):[_UFFN31 1.41k-ACITY OF EVERETT BUSINESS LIC.#(REQUIRED):057 bO <br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER (Please Specify) <br /> CONT <br /> ACT NAME: 1J CONTACT PHONE: 1 f/Z9 /� 7jag <br /> -r �� �Q� ,, <br /> CONTACT EMAIL: I (r I.-0 "X p 0I"/!xf /i / f 1 r 1 ,efi / , <br /> AGREEMENT T hereby certify that I have r d and exami d this application and know the same to be true an correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether sped ied 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 /> City of Everett Official Use Only <br /> FEE C <br /> Arl tj k --'' <br /> / „ / PERMIT# � <br /> . � f /i .774...774.. E 1 (60 bQ q <br /> Ow er/Mr 2-amr:• <br /> lgriat,til� /07/ Date (Revised 10/12/2015) <br />