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04-r ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 f <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov 1 www.ev: rt 9b�NAL <br /> ROJECT SI.T FORMATION <br /> PROJECT ADDRESS:S( ' 9 4Nv-id rn Je <br /> BUILDING AREA(if residential,new construction,remodel,or addition) k/ J/ ,7)i,J SF <br /> BUILDING TYPE: 1 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> . ..... . ELECTRI-GAL''APPLIG tto INFORMATIIOII F'aF <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Ato16 ci rc,;-r - 4/C ins-Ja1l <br /> ! �(ih0 til+': `a � .�. ia; - if"`iese, t xk rii a i .i 4 , i;. <br /> �, ���� ",t CONTACT ATIO I '��� a���a <br /> �. IN i> � -, t'�E�r"�-� �riz i�ii�. � a`r hcfi�^m�ti, ip �'%. il , 'al�f''e�(�t 4 I �.iM:.�a`�'� 04�. �..�ee .i t <br /> OWNER NAME: e.I t, / \ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ii( 1`U'Y)d l/Ji l Ave, <br /> CITY EVerL+-4' STATE r / (T( ZIP "(ia 5 <br /> OWNER PHONE: j�-�14- �� JJJ OWNER EMAIL: --- <br /> lV/��/� <br /> CONTRACTOR NAME:131(/e I L/A!/i, <br /> CONTRACTOR ADDRESS: STREET-/11 "iV (-5_i ) . I <br /> CITY /141/1--- STATE W� ZIP `JVVVy3 <br /> CONTRACTOR PHONE:itz5---p fr I`l01 CONTRACTOR EMAIL: -- ll��/ <br /> CONTRACTOR LIC.#(REQUIRED): Lob Fr�g3/'"l L I CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 77q <br /> PRIMARY CONTACT: 0 OWNER IRCONTRACTOR 0 OTHER(Please Specify) �-7 <br /> CONT CCT NAME: CONTACT PHONE: � 77( - ! a <br /> .)'J(� vv 0 1,-)1(04,{,,, CONTACT EMAIL:AGREEMENT*hereby certify that I d and amined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type 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 /> FEE <br /> 4$ 15, <br /> PERMIT# <br /> / / / 070/0E1, e0r153 <br /> s w'- •.f.. t Si:�. ur Date (Revised 10/12/2015) <br />