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ELECTRICAL PERMIT APPLICATION <br /> „It - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-B810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: RQOO 121M" ( 510CP <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: !at SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICA,L=APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 'J5-0 c�a <br /> NUMBER OF DEVICES (if low vaitage : <br /> FIRE ALARM? 0 YES ;;< NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable; <br /> DESCRIPTION OF WORK: ' l it .._t___ &!i _._ _ I_ r • ru <br /> CONTACT INFORMATION <br /> OWNER NAME: KeStIl <br /> ajcie.15, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sr ser I G)OO _1ZI '� J7 t jc) ✓A✓} i <br /> CITY F:Nerwdr STATE T! rep I(�g L../( ;. <br /> OWNER PHONE: 1j2.S -7 ' .324 7 OWNER EMAIL: <br /> CONTRACTOR NAME: C 1V,2-0 <br /> CONTRACTOR ADDRESS: STREET }t. 5 <br /> CITY k elf �y�t..i� STATE A ?IP 2c <br /> CONTRACTOR PHONE: 1-WS CONTRACTOR EMAIL: C e,b 1 e + yke„- g ' rn <br /> CONTRACTOR t_tC.#(FtEQUIREb) C.YYIr te. r tco"'1dw'C CITY OF EVERETT BUSINESS LIC,#(RECZUIRED); 1/20 <br /> PRIMARY CONTACT: 0 OWNER pi,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: � CONTACT PHONE: L f 5 359 D4 <br /> Wale'_ I e CONTACT EMAIL: debI Ver ,con-) <br /> AGREEMENT.I hereby certify that 1 have read and examined this application and know the same to be true and correct. Alt 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 tam 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 Official Use Only <br /> PERMIT# <br /> €12.0.6 aiwu i i 1"7 E - 09. 5 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />