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ELECTRICAL PERMIT APPLICATION <br /> • N4414 <br /> -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@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: t l)O\) R SSM <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF <br /> BUILDING TYPENSFR-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:$ (S-D, cl? <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES VNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ' Qp , <br /> DESCRIPTION OF WORK: .4)1'5 C'd rf•-'���T'/ J /�?N�v( G'i I7C , , 4)/c2/;v/a <br /> . . • • CONTACT INFORMATION • <br /> ; <br /> OWNER NAME: PcovvL= ,69/y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Silo /)dV <br /> CITY EV u r7 /�/¢ <br /> STATE (()A ZIP C�LC E <br /> OWNER PHONE:(7 zJ 35:5_1 7.7 OWNER EMAIL: /t/ <br /> CONTRACTOR NAME: C3' L--may cS �� �'�t� c ` <br /> CONTRACTOR ADDRESS: STREET 2120 r46.47-c. <br /> CITY alegar STATE We- ZIP IC(' <br /> CONTRACTOR PHONE(4/Z ) CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):,Y , ', <br /> f/ 5�jelOg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0071 5- <br /> PRIMARY CONTACT: 0 OWNER ITCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: I FZ�a 2�Z ��/4 <br /> L CONTACT EMAIL: /�� � ,..<25,57v7 lva..eaK <br /> AGREEMENT:I hereby certify 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 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 /> ppp City of Everett Official Use Only <br /> PERMIT# <br /> -,� e� 3. zs: « E 1(00 <br /> Owner/Authorized Agent signature Date (Revised 9/23/2016) <br />