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#1111P°. ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwagov I www.everettwa.gov/permits PROJECT SITE INFORMATION .> PROJECT ADDRESS i .+ ibC jj " yr I! l BUILDING AREA(if residential,new construction,remodel,or addition) / a 6 0 SF BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ) ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ ) NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 1O ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: K,) ef e mode CONTACT INFORMATION OWNER NAME: -141 �j TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET (..: If city k $. STATE ZIP OWNER PHONE: _ -5 44NEREMAIL: haF..epC41 i ern CONTRACTOR NAME: s'earlS / �yS!Twi 1 e G} i...J.t CONTRACTOR ADDRESS: STREET �/6 l -j - 132/10/ #WC AIF 007 CITY /' ono STATE 14 ZIP 973033 CONTRACTOR PHONE: 4125`-7325 SSSZ CONTRACTOR EMAIL: /1417-ts/nift)e(echic. de 4 CONTRACTOR LIC.#(REQUIRED): 1-I 6 H T .. 85-b N Q CITY OF EVERETT BUSINESS LIC.#(REQUI- D): PRIMARY CONTACT: Itt OWNER 0 CONTRACTOR 0 OTHER(Please Specify) 11,3 , CONTACT NAME: en c CONTACT PHONE: #2../ 3 .— �,�- ea �m I CONTACT EMAIL: '—I, ,y pith el eCtrt /lc e,q'yea.40A-3 AGREEMENT:i hereby certify that t have read and examined this application and know the same to be true and correct. All provisions of laws and ordixances governing this 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 stateor local law regulating construction or the performance of construction. That lam authorized by the owner of this properly to perform the work for which application is made and I comply with the State Contractors Law 98,27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 4011116,,,. • - .�,. : . /2.ç/ E t209- - 1 g Ow er/A,thorzed Agent ignature Date (Revised 9/23/2016)