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ELECTRICAL PERMIT APPLICATION <br /> "4111 -►-1 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@evereftwa.gov www.everettwa:govipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: IJ 4-s jI) 6t1 e.V- of er -o s <br /> BUILDING AREA(if residential,new construction,t remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR DETACHED.SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY #OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: li`C (vi rioj_ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: bp <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? C3 YES ONO <br /> ASSOCIATED BUILDING PERMIT a(if applicable):_ <br /> DESCRIPTION OF WORK: Devi oe 6.emovvr <br /> i <br /> � f .}, CONTACT INFORMATION 1 <br /> . <br /> OWNER NAME: 0 i�Zln ( t y() NAME <br /> (/� J(fTENANT (If ConertercW): <br /> OWNER MAILING ADDRESS: STREET (91P( D 1 T i I 1) <br /> ow EVERETT sT/te WA re 9'23 <br /> OWNER PHONE: I L [OWNER EMAIL:N/A <br /> CONTRACTOR NAME IN HOUSE ELECTRICAL SERVICES, INC. <br /> CONTRACTOR ADDRESS: STREET 1530 117TH DR SE <br /> coy LAKE STEVENS' STATE WA zra 98258 <br /> C NTRACTOR PHONE:425.760.3203 _ICONTRACTOR EMAIL: IHEPERMITSQa GMAIL COM <br /> CONTRACTOR Lam."(REQUIRED): INHOUES952QG CITY OF EVERETT BUSINESS LIC.*(REQUIRED):044168 <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.760.3203 <br /> KELSEY CONTACT EMAIL:IHEPERMITS acGMAIL.COM <br /> AGREEMENT:t hereby cerlay dntt t have read end examined this mon w.d k owme same lobe Sue and correct All provisions ofawsa ndardawnoesgoverrrtng this-type <br /> of so*wilt becompleted whether specified home)ornot me granting o/spanne does not poem.tgive. ytoviolate,orcancel Ste naoanyotherstaleor <br /> local law teouieting construction or the perfonnence of aofgkuCtcn. That I am authotttedb/the ovate,of thhiptopertylo perform theme*Ay which appacation is made endt <br /> comply wkb the State Contractors Law 18.27RCWend 29200 WAC. <br /> City of Everett Ori Use Orly <br /> PERMIT# VG� <br /> ob.. l ;% ``./� '�- 12 r e E ( S02-r l <br /> owner/ r r.�:: . re "w Oats (Revised 9n32016) <br /> Scanned by CamScanner <br />