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( 4kECTRICAL PERMIT AALICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> . . - lI�>i3.��A��`��9�� IFIF®rzMd�.Tic•�� `:. . _. <br /> 'PROJECT ADDRESS: 51 1 T cQ J v c,1,1/43 tom V q, eVc r(-t �U 9 4 _03 <br /> 'BUILDING AREA(if residential,new construction,remodel,or addition) / 1 -( / SF <br /> 'BUILDING TYPE: 0 SFR-DETACHED ESI4SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: q . t(2,n/ c _ <br /> ELECTRICAL AP LICATI• ' I FORMATIION <br /> CONTRACT PRICE OF WORK:$ 60O0 <br /> NUMBER OF DEVICES(if low voltage):• 1 Z <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> 12-C,r Lal t et <br /> : . ; �• ;:CONTACT INFORMATION. :::.. <br /> OWNER NAME: Prk t,>14,1v cke"( MQf& TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t,ot 3 SS U to it Ps <br /> crnY ft 0 ) \ STATE J ZIP 1 aD 0 <br /> OWNER PHONE: 42OWNER EMAIL: PA e;Act,td.)at el S4)00i .CIJOcL Corn <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER (0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME::, CONTACT PHONE: Z.E 15 3 1 81- 9 <br /> 4-t xotlJc:er Pst.Aky`2Z CONTACT EMAIL: ti J-I✓Xa Lvueta.,36006 deita. <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 l am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE 5 <br /> 0 a51- <br /> PERMIT# <br /> H <br /> 1 1 5 ? <br /> Owner/Authorized Age Signa Date (Revised 10/92/2095) <br />