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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 3 ra <br /> BUILDING AREA(if residential, new construction, remodel,or addition) .O O SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED jR1 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /0( oc <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES el NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: -0--e-10, (se- ba tv �r-l-r o fr-e l"nrrs(: -,`x►.$ <br /> • <br /> `�'� 'CONTACT INFORMATION <br /> OWNER NAME: t2wr\ r�Y�� J/Y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /'3 <br /> CITY (.`(C.fY41V STATE Dk ZIP R g c <br /> OWNER PHONE: c XS--3 q L( - 2,5 SCS OWNER EMAIL: <br /> CONTRACTOR NAME: rv\ `e l-66-tr-,c, L(�C- <br /> CONTRACTOR ADDRESS: STREET to,at° )7 <br /> r Dr me <br /> CITY J STATE 01 --)(� ZIP <br /> CONTRACTOR PHONE:4 CONTRACTOR EMAIL: / , ,61:ee'(,'10, IS© tM.2,(,CCY"\, <br /> CONTRACTOR LIC.#(REQUIRED): A/1,c O('-/? $ 5 I/ 7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Q5 6:3,-q <br /> j <br /> PRIMARY CONTACT: 0 OWNER 16 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1,o,.._5--sc f S_6,cp <br /> �LL4, 4-4 11A.Q sof. CONTACT EMAIL: W`.g,so/\ -e,f eco— ; ,r CSI INV' ( • CO/1/4'N-- <br /> AGREEMENT:l ereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws an ordWaances 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 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 I ' 010 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />