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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 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: g-f2 q_ —707L,0 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: li.SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: O COMMERCIAL <br /> USE OF BUILDING: • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ by, <br /> NUMBER OF DEVICES(If low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> (-)\t?,(Ay.i LAA Qu e S 1M <br /> 9 <br /> • <br /> • • CONTACT_ INFORMATION <br /> OWNER NAME: 8((,&I3 13 Le,610 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2(q'--'.76 24 P� (.571(,), ^^ �/f� <br /> crYY tf�i Cli 1J� STATE LaA . ZIP ge G.0✓2 <br /> OWNER PHONE:( 'Y'c) 501 - C'Z,:Z1 OWNER EMAIL: <br /> CONTRACTOR NAME: Ul -may ✓Jc44-re 1-}�'� lA�( <br /> CONTRACTOR ADDRESS: STREET (sl 0 t7 (Jt G ,_ <br /> CITY 6' [j STATE (AM- ZIP f1— <br /> CONTRACTOR PHONE(41Z$1 L5-2.-3 1 l y CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):,i%f/OZ.6,5celge giv CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O/(;(5c <br /> PRIMARY CONTACT: ❑OWNER ErCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t.( , 25 Z_J <br /> f�^L(..) CONTACT EMAIL: JC�i r &5,57{,-/ ivy,&eh/I"( <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 lam authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E 19 \ - 1l0 <br /> Owner/Auth !zed Agent Signature Date (Revised 9/23/2096) <br />