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/11/00 .r/-----4 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 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: . V/B ,.J0/1-0iJ ,(/e" 6"Ve-!e-
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) T 0 SF
<br /> BUILDING TYPE: 0 SFR-DETACHED la SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF U S: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> i
<br /> ELECTRIC L APPLICATION INFORM 'ION
<br /> CONTRACT PRICE OF W .$ /$Ob ' `�' / N
<br /> NUMBER OF DEVICES(if low oltage): /
<br /> FIRE ALARM? ❑YES ,Pt NO
<br /> ASSOCIATED BUILDING PER #Qs a icable): \\,
<br /> DESCRIPTION OF WORK: / a.,h J J6.,7L. , Ode/ ( ;�
<br /> Ili'
<br /> AstrtL ? C.Itr;• ,1/4 4.! /ik W
<br /> C.NTACT •RMATIION
<br /> OWNER NAME: ,049/,c, '/ Co//jdr,J TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3 L//. ' totJ D rlL-nnJ A l/f
<br /> ri/.
<br /> CITY e-/� .9ff STATE Com, . ZIP 9626/
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: ,C A,,,..70., �`-O,t- -r fTzA I ca.,,,,,//i t,e,S (7,,,,-61:7
<br /> CONTRACTOR ADDRESS: ST ' /4/3/g Z6 6./L (//L-c,/,& Ne'r
<br /> • O(J V/ti// STATE (A//�d" ZIP 9 6/191
<br /> CONTRACTOR PHONE: (,/L.-, 3s-9—8 9 'S (CONTRACTOR EMAIL: a ;I /eur/-,'r, OV44Siv,C,C)/1.••
<br /> CONTRACTOR LIC.#(REQUIRED):EAST t S e-/ 6— CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER ( ,CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: VZ,$/—?5-9 —e4 9 c
<br /> J�. �1 �� z, CONTACT EMAIL: e Ti44f.2,17,4-/f,49,v'-SNrCo/`^'
<br /> AGREEMENT:I herebje ✓�
<br /> rtify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances 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 f 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 /> . �/D/2 E S - o c:t
<br /> Rymer/Authorized Age ignature Date (Revised 923/2016)
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