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ELECTRAL. PERT PC `TI N <br /> CITYODF EVERETT PERMIMITASERVICES <br /> 3200 CEDARICSTREET, EVERETT,WAPLI98201A <br /> (P)425-257-8810 J FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: "2.32.0 ��t�' �J� (,�KI tr53 tl s <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: D SFR-DETACHED D SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: IICOMMERCIAL <br /> USE OF BUILDING: • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ TOLj, <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? D YES D NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Ors 6 0 <br /> '[2 p l A c ut-L5-r <br /> • <br /> CONTACT INFORMATION • . • • • - • :. <br /> OWNER NAME: �itFxta pc^ ,,( o 4Cy TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 09, 130x 540"3 <br /> CITY t,-J' STATE (-til ZIP WZOI <br /> OWNER PHONE( f Z �5g_. r/O Si OWNER EMAIL: <br /> CONTRACTOR NAME: <rtJ( 2I ()l4Tt'ir 1-} l <br /> CONTRACTOR ADDRESS: STREET I G <br /> �(�( <br /> fZ • <br /> CITY 4�iz( STATE (..64- ZIP rbc( <br /> CONTRACTOR PHONE(cezg) z-C2--- 3() ty CONTRACTOR EMAIL: /41t QV S r,,•l Lc�c SCJ <br /> CONTRACTOR LIC.#(REQUIRED):re/ 61',V7 ) e CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 6/c,Yj5 <br /> PRIMARY CONTACT: 13 OWNER Et CONTRACTOR D OTHER(Please Specify) -CONTACT NAME: �'' CONTACT PHONE: lfZ 2�2 —3//it <br /> jE (�) ,.ST CONTACT EMAIL: k,C cQ`,571,7 te-iet,ea <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 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 /> LeA'‘ — 3-- 71 E <br /> PERMIT# <br /> Owner/Author zed Agent Signature Date (Revised 9/23/2016) <br />