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/j--14 <br /> •=ECTRICAL PERMIT AOLICATION <br /> '4dWCITY 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 /> � <br /> q �J PROJECT SITE INFORMATION <br /> Li PROJECT ADDRESS: 3 11 14 CI y P S} w .1\ °-8 ac) <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: Aavo0A 0(2_5 el 5 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 66(i <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: 3C) 65^12 Cir-co,3- ..4•r 6tiC} ke- 5 kt-L•4-1 'f /4C <br /> CONTACT INFORMATION <br /> OWNER NAME: 6•,1\ (-,p dO TENANT NAME(If Commercial): AavG'Y1 -e IDQS iaf V\ <br /> OWNER MAILING ADDRESS: STREET " \ J <br /> Cim' Qr'�-'1"� STATE ' A ZIP 9-Z2°\ <br /> OWNER PHONE: (4.7 ) 2-59 - 19 2J OWNER EMAIL: b; I I _.c1Cf i 1Y1 .ca. Lc,P"'") <br /> CONTRACTOR NAME: O' )6c.ir• j /c'C,fr, c Li C.. <br /> CONTRACTOR ADDRESS: STREET 2- 2-3 0 1 PL L..., <br /> CITY Ly n✓t ' G/ STATE (.AJ A ZIP CN 0 3 <br /> CONTRACTOR PHONE: (-'II z ) �jj� (- 7 '2CONTRACTOR EMAIL: 3 CICO b O k CC se-0 ccE r ,�� Ca-rt1A i <br /> CONTRACTOR LIC.#(REQUIRED): O &EA EL%`15 a t2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 22215 <br /> PRIMARY CONTACT: jSrOWNER 0 CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (k2S) 01- 11 Z`T <br /> \E [(l J c Ccs s U (•tsl✓C 1-eC_j r. L 7✓ i tc, c� CONTACT EMAIL: .) y <br /> AGREEMENT: T hereby certify that l 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 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 /> FEE <br /> PERMIT# <br /> J/r � � 1 / 12 ) 1L, E <br /> Owrier/ uthorized Agent jnature Date (Revised 10/12/2015) <br />