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41-77- 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: D� '2 Q lV�n l S I i W/1" a Cr7 O\ <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED =i SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 1lUI(/'� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ `620 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):� <br /> DESCRIPTION OF WORK: ( I ) (.I 1eI fi jl((i() it ID 01. 1I�1/11- S cSI/v 11G(r\ <br /> CONTACT INFORMATION <br /> OWNER NAME: CO/ Vile N.J &I do oul TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2-1 <br /> O,- CITY *E- STATE STATE �/ ZIP 4 <br /> 92-0 <br /> C�� 1 <br /> OWNER PHONE: J 2 [ >��, OWNER EMAIL: Al �4 <br /> CONTRACTOR NAME: /� L455-1C-0-1171C.- <br /> CONTRACTOR <br /> C-0 t C- /, <br /> CONTRACTOR ADDRESS: STREET ) O 1 17-11 7 /�D, CSE /^/ (� <br /> CITY /—A-1<e (f-�V✓l/ U STATE t V ZIP / t/2 <br /> CONTRACTOR PHONE:X/2 7(a U 3Z0 CONTRACTOR EMAIL: 11/l`P/IYc91 /rS „9//vi cull-6047))' <br /> //VCONTRACTOR LIC.#(REQUIRED): � 1 t (1 E 15 Z �67 CITY OF EVERETT BUSINESS LIC.#(REQUIRE',iD`-t�-/10 Q <br /> PRIMARY CONTACT: 0 OWNER "CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:421 0"- D -7 / 7�/ <br /> CONTACT EMAIL: / ITS VVZGC4 / • <br /> AGREEMENT:l hereby certify that I have read and examined this application and know the same to be true and correct. All provisions&flaws and ordinan<es 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 Officit. Use Only <br /> / ". PERMIT# <br /> (1 E1OI <br /> Own• /Authorized Agent 5'.nature ■ate (Revised 9/23/2016) <br />