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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 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT.SITE INFORMATION <br /> PROJECT ADDRESS: d ' 2. ( /1 l e I")„,- Se-tt-A <br /> BUILDING AREA„;1residential, new conss:ru✓ction, remodel,or arid:tAdni <br /> SF <br /> BUILDING TYPE, FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS 0COtAN1ERClAL <br /> USE OF BUILDING: <br /> ELECTRICAL.APPLICAt1ONr1N R A ION <br /> CONTRACT PRICE OF WORK: $ I 5c) . <br /> NUMBER OF DEVICES (if low voila $): I <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#Of appl1cable)' <br /> DES CRIET1D_N_OF..WORK: <br /> ...._ ..._ <br /> 011. <br /> *,C1 N1°Nl+(, ORtM A'?I <br /> 7"At '1'�- ON <br /> 4.0 r <br /> OWNER NAME: 6 ,. <br /> an TENANT NAME(If Cvnrneerdfdl)t <br /> DWNER MAILING ADDRESS k.c)t �* <br /> STFte ET �` t-7 <br /> cmr k��.. p j✓QC's.. _ DP SZCZ <br /> �,j'� { J sraT� �r� :,,C.jC1 <br /> OWNER PHONE: i " <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: CI t /` <br /> CONTRACTOR ADDRESS: STREET r t <br /> cn.. <br /> STATS A ziP a 2o I <br /> CONTRACTOR PHONE: • <br /> e ►-�' + 0 • CONTRACTOR EMAIL: ! ',/s r <br /> .:C}NTF'�JA�"t"�51�i.C��'.°.��F2`EQt11RE17���.�1�� .t!/ 49.4; 9 r J VI'?� city(*EVERETT BUSINESS LIC,#REQUIRED. �. _ <br /> PRIMARY CONTACT: 0 OWNER t ) � Q <br /> CONTRACTOR ❑OTHER(Please 5peclfy) <br /> CONTACT NAME: <br /> CONTACT PHONE: R5 5q C <br /> oiala ie. <br /> CONTACT EMAIL: deb! � , <br /> AGREEMENT:I hereby certify that t have read and examined this application and know the same to be true and correct. All provisionsgy ,oflaws anddoordi>ances governing this type <br /> of work will be completed whether specified herein or not. The granting of a pelt 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 1 am authorized by the owner of this property to perform the work for which application Is made and l <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> €.3aPif .30 E cOof - g <br /> Owner/Authorized Agen2LL <br /> t Signature <br /> Date <br /> (Revised 9/23/2010 <br />