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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES467"7 <br /> 3200 CEDAR STREET, EVE ETT,WA 98201 <br /> (P)425-257-8610 1 FAX 415-2578857 I(E)e r tteps vsret a. ov I vvvvw.everettwa.govipermits <br /> PROJECT SITE IINFORMA°I <br /> : <br /> PROJECT ADDRESS: li ®.. <br /> BUILDING AREA(if re 'dental,new construction,remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED EI,DUPLEX C :MULTI-FAMILY-*OF UNITS:fp <br /> , CI COMMERCIAL <br /> USE OF BUILDING <br /> ELECTRICAL AFPLICAVIOI4"INFORMATION <br /> CONTRACT PRICE OF WORK:'$,'* ,,; i <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? E7 YES Cl NO <br /> ASSOCIATED BUILDING PERMCI`'#(if applicable): <br /> DESCRIPTION OF WORKaa <br /> , „, <br /> .. <br /> CONTACT INFORMATION <br /> OWNER NAME. Ykl It ..: .l "'Bka <br /> TENANT NAME(If Commercial): <br /> DINER MAILING ADORE a er <br /> sTA0104. i <br /> �""1 <br /> OWNER PHONE; rt# r ' [OWNER EMAIL: *""""- <br /> CONTRACTORrobtNAME: 4t <br /> t A, k <br /> CONTRACTOR ADDRESS: <br /> b w <br /> CONTRACTOR PRONE: h ;q , JQNTRA(TOR EMAIL; i,. <br /> # 4, <br /> CONTRACTOR LIC.:#@REQUIRE?}: .I • CITY 0,F ELiERETT BUSINESS LIC.#(RE9uIREDt, <br /> PRIMARY CONTACT: 0 OWNER i® ONTRACTOR CI OTHER(Please S. clfy) <br /> C' T'CT NA E: CONTACT PHONE: <br /> r <br /> %t I► :# 1 1 '46111 CONTACT EMAIL. t t a.i Imo. , p 14 A fi 1 ii # 6 <br /> AGREEMENT.I hereby certify,at t have read nd_examia ed Phis pplication ar fk{friar the came to be true obit coned. .#Prov siOna of laws and ordinances governing this*pa <br /> of work will be completed whetherspecifted herein or not, The granting of a permit dove not presume-to give authority to violate or cancel the pfovisione of any taf#lorstate or <br /> local law regulating construction or the performance of€onstruchbn. mats am autred by the'molar ofthis property to perform the imorir for which application is made and I <br /> comply with the State Ct ntrecidta Law to 27 RCW ant:1196,2W[AJAR <br /> City of EEerett Official Use Only <br /> ‘,„,,sliiiiwiiik <br /> PERMIT <br /> . ,.40 . . .ur i <br /> E fel 0 - arC <br /> O or/Authors =_ •,iertt W ature W'`"° Date (Revised 9•23/20/6) <br />