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LECT ICAL PERMIT APPLICATION <br /> -,- CITY 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 /> PROJECT SITE INFORMATION': tl <br /> PROJECT ADDRESS: r(V Gr"Sr sc. `7,4-e / W (O 5 'ca-4-1- OV VP - <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 12/COMMERCIAL <br /> USE OF BUILDING: , eACtw pi9 CS <br /> CTRICAL APPLICATIO... RMATION:.: <br /> CONTRACT PRICE OF WO :$5O Q `F 1✓•L Li (rj• <br /> NUMBER OF DEVICES(if Io voltage): I <br /> FIRE ALARM? OYES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): • <br /> DESCRIPTION OF WORK: a I 77114/•- ®F 6, teaGe <br /> CONTACT;INFORMATION <br /> OWNER NAME: bt/Seot ,t gerCL(f TENANT NAME(If Commercial): l<S h 75 01 S ca7t le <br /> OWNER MAILING ADDRESS: STREET (p CO`. ?jl S r w' <br /> COY E S STATE to ZIP g g01,0 <br /> OWNER PHONE: Z.15C 55 3 3 71 OWNER EMAIL: /1511.15' Qw`S ri <br /> 7 T ,�� <br /> e la c#04.01,t /•G0 <br /> CONTRACTOR NAME: /PO -6fres 1- fle�fo <br /> CONTRACTOR ADDRESS:// ''� STREET !f t6 57' n - Sr I� <br /> CITY C' Pj/1 STATE M/ CN.-.. ZIP se?Q( <br /> CONTRACTOR PHONE: 0-696" 55( 3,7 I CONTRACTO- Er J <br /> CONTRACTOR LIC.#(REQUIR ,: �o �� y i pig • ITY OF EVERETT BUSINESS LIC.#(REQUIRED): �5D``�°1 <br /> PRIMARY CONTACT: ❑O R CONTRACTOR ID OTHER • -ase..ecify) <br /> CONTA NAME: 5 <br /> : IDG✓ ail CONTACT PHONE: �� �5� /3 71 <br /> (h l Lviotili eA- CONTACT EMAIL: <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!am authorized by the owner of this property to perform the work for which application is made and! <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 -01 . 5g <br /> _____-- . <br /> PERMIT# <br /> / (0- pbt-i <br /> _de .7 _ goilll _ <br /> Ow ,r r,Pient Si••. ire Date (Revised 10/12/2015) <br /> �� 2 <br />