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0 <br /> bLECTRICAL PERMIT APPLICATION <br /> h � CITY OF EVERETT PERMIT SERVICES <br /> ',41W1 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: t Z (-rte, <br /> BUILDING AREA(if residential, new construction,remodel,or addition) I/ 0 SF • <br /> BUILDING TYPE: ❑SFR-DETACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: yfz-s.a)WiA-1.-- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $T�000. <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 7k <br /> DESCRIPTION OF WORK: Mt is z, ()A-0 `(r/fl gratfl,i ;i hrcg. f�'DP)nt7- <br /> DS4Aulc( T71-/J3 itV{- s_. <br /> CONTACT INFORMATION. <br /> OWNER NAME: 9TIN J� (PAS TENANT NAME(If Commercial): �/� <br /> OWNER MAILING ADDRESS: sTREE•r ``I 1 p4 PE" (PAS �J <br /> crr o� STATEkikZIP Cl 0 0 U 4 <br /> OWNER PHONE: •.7,0_4_7 (tf— 3 O� OWNER - GAM- . <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET • <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> - K <br /> PRIMARY CONTACT: 1 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) ~W'�A�w'.�~'�yA�'��v�'���_T�,�sYt`-Yl'SUAm�,.Nnww_x_,_� <br /> CONTACT NAME: -0-g iu yt, / CONTACT PHONE:204 .- b�fCF 3do3 <br /> CONTACT EMAiL: -I g <br /> AGREEMENT.T hereby certify that I have read and examined this application and know the same to b true and rect. 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 uthority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 6O1 <br /> PERMIT# <br /> \\!,► cV1B(u9— E 1705-1(3 <br /> ner/•uthorized Agent Signature Date (Revised 10/12/2015) <br />