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ELECTRICAL PERMIT APPLICATION <br /> 0 ,, 1Hr 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@everettwa.gov I www.everettwagov/permits <br /> PROJECT SITE INFORMATION <br /> m <br /> PROJECT ADDRESS•,, OO O t ► ..t,1 Ix 1, 1E\Y“' C'` } C <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED iR4R-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS:_ 0 COMMERCIAL <br /> USE OF BUILDING: a. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low volts.° <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT &I ap.iicable): <br /> DESCRIPTIION OFORK: 0 I L., -R.,, I 4., * VE,.. +".'t <br /> k r Vv v <br /> E <br /> CONTACT INFORMATION <br /> OWNER NAME: F-k- k Cc r berdo. 0 TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STM-I,,;r ! <br /> c, <br /> Cry STA2 Z <br /> OWNER PHONE:'"` 5 ` t 5 1 {WNER EMAIL: <br /> CONTRACTOR NAME:,Brennan Heating <br /> CONTRACTOR ADDRESS: 51.R.,4601 4601 S 134th PI <br /> tc,t Seattle s AttN Wa t4p 98168 <br /> CONTRACTOR PHONE: 206-248-7900 CONTRACTOR EMAIL: Jaimie f Brennan 'teating.COM <br /> CONTRACTOR LIC.#(REQUIRED,): BRENNHA962DU CITY OF EVERETT BUSINESS LIC.#(t EOUitRl D 028230 <br /> PRIMARY CONTACT: 0 OWNER 2 CONTRACTOR 0 OTHER(Please Specify) -. <br /> CONTACT NAME: CONTACT PHONE: 206-248-7900 <br /> Jaimie How CONTACT EMAIL:Jaimie@a brennanheatin .cQm <br /> AGREEMENT I hereby Certo"that I have read and examined this app/teaeon and know the same to be two and correct. All provisions of laws oh/o'canancas:governing ties type <br /> of work wf be completed whether specified neretn Or not. The granting of a patnst does riot presume to give authority to violate or concert the provastr€ns of any Other slate or <br /> total taw regulating construction or The performance of ceostructran; Thor I a€m authoritwd by the owner of tftas pr rty to perform the work for which apple oteon r r Made orad t <br /> aompty with the State Contractors Law 18 27 PCW and 298,200 WAC. <br /> city orf Everett Oficial Use Only <br /> ... ...,,..\..._, <br /> L , <br /> PERMIT^# D'4—()--:3S <br /> --t I <br /> Q., 1 <br /> , E <br /> e,' erlAutharlxed Agent signature Date (Revised 9/23/2016) <br />