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414-77- ELECTRICAL PERMIT APPL;CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Ia ..� .?j -?7 C,.1 \f.) 4- `19,;244. <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ a9Zi;� <br /> -- <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1 p1)k II pot, c� J J1 ,ins: Cfj� (31,4,4 :^('r Le4et Ca <br /> 1( C' i.>-1`-ky <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial):Lusi.r'L i t L <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: //OWNER EMAIL: / <br /> CONTRACTOR NAME: ,1/jit4.71 i‘t1E(�r r()�'J -) /i, ii7tAZ ) 4 <br /> CONTRACTOR ADDRESS: STREET 1 p<)?� � ,,E611-6 <br /> qA ���'''``^��� <br /> CIT STATE L� ZIP 9Pj G'�` <br /> CONTRACTOR PHONE: q).S-•S[7 J•- CONTRACTOR EMAIL: ; 1/ Lk re?Ll.l.[1 7./lei La!'c') <br /> CONTRACTOR LIC.#(REQUIRED): j jL J\ /V\ dJ*`7) 1 Cr, CITY OF EVERETT BUSINESS LIC.#(REQUIRED):1-rj <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All 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 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 Official Use Only <br /> PERMIT# <br /> v76)A. E t - nig1 <br /> One uthorized Agcht Signature Date (Revised 9/23/2016) <br />