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4277- !LECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES LoRIG�A, <br /> 3200 CEDAR STREET, EVERETT,WA 98201 1 V AL <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> " r1r"."bGir 19J0TI <br /> NFO MAuu � ®:y: F l. haill a , <br /> PROJECT ADDRESS:� ? �� <br /> ` �j 4i��- �(� �" <br /> BUILDING AREA(if residential,new construction,remodel,or addition) �2: x SF <br /> BUILDING TYPE: 0 SFR-DETACHED,'SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> `: ELECTRICAL.APPLICATION INFORMATION , ~ . <br /> CONTRACT PRICE OF WORK: $ (,Q,6 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: c C 1,V 0.44* (-Puy- A(i 'iS' <br /> 0111/41frlif c k-s CSI Com ) <br /> 'I z CONTACT'INtFORMATIO€N <br /> OWNER NAME: PM\ _Pa TENANT NAME(If Com cial): <br /> OWNER MAILING ADDRESS: STREET c* FAA/V.41S UV - , <br /> CITY/ 1J �Ci' j STATEIA- ZIP CL r-`) <br /> OWNER PHONE:r2A-5\e-: �- (12r1(42,CH/v1/-/i. <br /> OWWNER EMAIL: {IA L <br /> CONTRACTOR NAME: P.- �11 CH vl�/, <br /> CONTRACTOR ADDRESS: STREET" I L //"7.."&"-,1-- (6'�3� �!' <br /> CITY V� STATEIA) ZIP CI- -1� <br /> CONTRACTOR PHONE:1----)/C- '1A\.,11141 CONTRACTOR EMAIL: In, ( C4 <br /> CONTRACTOR LIC.#(REQUIRED):l t 3 c/-A l,)- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ( 11010 <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTCT NAME: I' CONTACT PHONE: l-'Lc` --n 1. "� t 1 <br /> ... <br /> t 6'. 1\-)WA 1,2i CONTACT EMAIL:ni I <br /> 01 <br /> AGREEMENT:T 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 <br /> type 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 lam 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 /> FEE <br /> 4 15 <br /> ‘ aPERMIT# <br /> , r 0 40 \/l , f 1 g E l bCP-L� <br /> Owner/Authorize• •gent Sig Date (Revised 10/12/2015) <br />