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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 www.everettwa.gov/permits <br /> 'PRl JECT SITEINFORMdl''!I`ION <br /> PROJECT ADDRESS: 2322. 1C.D"7 t'' FL 5t <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: r. SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> '''Etatttitid4LIOrkLIOAtitiNli_ilFORMA rk N <br /> CONTRACT PRICE OF WORK: $ ( <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):: <br /> D .ESCRIPTIONC7F WORK Ilea** <br /> 1. ! 1 l ...._ ',. <br /> cON'llAa 14 ORMA tlaN <br /> OWNER NAME: 3, Plot4Ve.41er TENANT NAME(If Commercial}: <br /> OWNER MAILING ADDRESS: STREET Z g22 1CT' PL, SE <br /> LA) <br /> 1 l/77 a/.��Q /r��yy <br /> cm ,�f . r. STATE `A , r zip t O \.../G7 <br /> OWNER PHONE: q1 21717 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 1.4 Jp r5 W}Q„�5,' V n,l [� <br /> p , CITY � lf�J '� �! STATS \J -' <br /> /� ZIP LJ 2o I <br /> CONTRACTOR PHONE: e.5 r�7t"'t 0'70, ► CONTRACTOR EMAIL: I ',#Ra. 11t # + a <br /> _.._"CON <br /> JHAteCTOTCTC.#REQUIRED):CY ��(� 't CITY OF EVERETT BUSIN <br /> ESS LIC.#RE1 <br /> U1RE0)a � 0.11(:2)-__ <br /> PRIMARY CONTACT: 0 OWNER p,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: 1-.15 35C1 <br /> �C. CONTACT EMAIL: . • i�t�-,s• r <br /> AGREEMENT:I hereby certify that t have read end examined this application and know the same to be trueand correct. All provisions,of laws end dordir ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does notpresumeto give authority to violate or cancel the provisions of any other stale or <br /> local law regulating construction or(he 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 a/Everett Official Use Only <br /> PERMIT# <br /> MLR)1 5 .4 5 <br /> Owner/Authorized Agent Signature I �� �� <br /> Date (Revised 9/23/2016) <br />