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44.77 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> • <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 15.21 _— S (V. S� <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ySFR-DETACHED 0 SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 25CV <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> DESCRIPTION OF WORK: D(s C.Ot`V._ .,_-r 'L 0,-4.bt..(...:( LorV(T"S <br /> .( <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: l^--,...‘ OA((4t4A i J TENANT NAME(If Commercial): <br /> � k� <br /> OWNER MAILING ADDRESS: STREET l 5 1 — s 3 1C('''� , Sl ) LOA�AA <br /> CITY 6j �err - STATE LOA , ZIP VCi 101 <br /> OWNER PHONE: OWNER EMAIL:A <br /> CONTRACTOR NAME: I.VE �y cf -re 171 1 6 <br /> CONTRACTOR ADDRESS: STREET 2.120 %21.-C <br /> CITY aiq2err STATE (.1.1)* ZIP ( 51.a <br /> CONTRACTOR PHONE(c'z0 2g2..--.31/tf. CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 055 j/ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):007N�' <br /> PRIMARY CONTACT: 0 OWNER f tCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: tfzs,- 252_— 3f/9- <br /> 14.- <br /> 9 <br /> 1 3,�LC CONTACT EMAIL: gi,g rti &;S/try Luee..GI'i'( <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 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 ROW and 296.200 WAC, <br /> City of Everett Official Use Only <br /> PERMIT <br /> 7 - e--ii <br /> E 1 q oi --.(16 <br /> OwnerlAuthoriz d Agent Signature Date (Revised 9/23/2016) <br />