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04 ELECTRICAL PERMIT APPLICATION <br /> - CITY OF EVERETT PERMIT SERVICES 7-7 <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.govfpermits <br /> PROjz_OTSITE INFORMATION <br /> PROJECT ADDRESS L 0 W <br /> BUILDING AREA residential,new 3ans'r;;;6:;^ re.-node,or a:ditihnj <br /> 5F <br /> BUILDING'TYPE.: ❑ SFR-DETA kE'? ❑ 3,-----R,-ATTACH-7:1); 0 DJDL=- 0 X ,11;JLT, ;h,-r , <br /> 411L1'-#OF UNITS- 0 COMR-tEr',CIA_ <br /> USE OF BJILDtNG: - ------__-. <br /> ELECTRICACAPPLICATIoalOtORMATION <br /> CONTRACT PRICE OF WORK: $ cCD a' <br /> NUMBER OF DEVICES (if low volts e <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(i;applicablel: <br /> O_ESCR1E...T CIN.QEWORK:__._ ...__ <br /> OWNER NAME: DCA n rn CI oefor. t,` m <br /> { TENANT NAME(If Cornar-sal : <br /> OWNER MAILING ADDRESS: Sri =- o �j <br /> % 't,�..tj, -j ' C <br /> qqa <br /> TOWNER PHONE: 2S:::)(.0 y 1, sra z!P X5.03 <br /> C10-i "�i Oa�l lOWNER EMAIL: <br /> CONTRAOTOR NAME: (Lrirt <br /> CONTRACTOR ADDRESS: � ? I o <br /> ach <br /> CITY #J J,. ..a A ZIP q 2421 <br /> STATE <br /> CONTRACTOR PHONE: • . � <br /> �1 F • +� CONTRACTOR EMAIL: dp %,„ s� '" . 4 <br /> C6NTR-.KCTCRZ.T�.#(E�F.ourRt=6 : �� - t /, � a YVl <br /> • �_._ "C[TY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT; 0 OWNER 'X CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: L 55 a5q oa c is <br /> e%'F►•�( (G CONTACT EMAIL: .Q 'j .yUw <br /> AGREEMENT.I hereby certify that I have read end examined This application and know the same to be true and correct All ov f-Ctri ,corning work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to vial visions <br /> ricancel the provisions of any others tatehrs orryp9 <br /> local law regulating construction or the performance of construction. That 1 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 /> i PERMI # <br /> �-- i2L . r E 1 t.0D ' <br /> CwnartAnthorized Agent Signature <br /> Cate <br /> (Revised 9/23/2016) <br />