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i <br /> "Iiiiid-°—.4 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 J (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION°' <br /> PROJECT ADDRESS: ‘. 24//' i ..--- ,a,.-ice, #' t/4 921,203 <br /> BUILDING AREA(if residential,new construction e ode addition) /53- SF <br /> BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-4 OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Ce'/4 c e <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ / 2 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0•NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):�� t/ <br /> DESCRIPTION OF WORK: �c0�7! .1(i /67‘14,1 nFv �J <br /> 's�e f- <br /> #i �4'v,.ems <br /> CONTACT INFORMATION <br /> OWNER NAME: �-q &.,-_,L,,,, --.4, TENANT NAME(If Commercial): �/ �,, <br /> OWNER MAILING ADDRESS: STREET ,200 '7, /!jam A-. .iW/ pi/if 23 <br /> CRY �. STATEEZIP <br /> OWNER PHONE: roK 250--c�/jg OWNER EMAIL: et,--4 m hG4c4/q�/� 0/ /l+ c-vas,J <br /> CONTRACTOR NAME: e/l2.4y,‘,.�--- <br /> CONTRACTOR ADDRESS: STREET <br /> CnY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and coned. 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 /> . FF�� <br /> t,L ) oC , °- <br /> 4J <br /> co4e <br /> ya._._._.____,_/,_e)z2,_/y PERMIT <br /> E roe-I- 11/ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />