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10177 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 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 7C2;(1 , 1.7f4 � ( <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ eq00. LL//-- <br /> NUMBER OF DEVICES(If low voltage): ( t Pat Z -rt> Octd(as S 1`�F� '� RI <br /> FIRE ALARM? 0 YES 'VNO 1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Los DESCRIPTION OF WORK: Ru 1_1 Pei , t trot. c FPS c h L(.I <br /> CONTACT INFORMATION <br /> OWNER NAME: �tO, 5 C Zb TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j(t, -- (7 fti fi q <br /> CI Y STATE WA 4 ZIP c-z0 <br /> OWNER PHONE:(?..190 6Lt 7 -- '7OJOWNER EMAIL: <br /> CONTRACTOR NAME: -,JL" jEZ.( ` -T 2 (-4 ! eke._ <br /> CONTRACTOR ADDRESS: STREET 21 • PA{• -Re: <br /> CIN W '- <br /> L\ STATE 'l CJ�ZIP 0 O CfIJ( <br /> CONTRACTOR PHONE 7_,C2--- 3114 CONTRACTOR EMAIL: lee to S5lM tvu.,Ltnet— <br /> CONTRACTOR LIC.#(REQUIRED): q'76 RAi CITY OF EVERETT BUSINESS LIC.#(REQUIRED)0(77/53— <br /> PRIMARY CONTACT: ❑OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ail 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 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 /> PERMIT# <br /> gY - EL&R O5g <br /> Owner/Auth rized Agent Signature Date (Revised 9/23/2016) <br />