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477 LECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ‘-- <br /> PROJECT SITE INookolATIoN., <br /> PROJECT ADDRESS: j CeZt 1/10tt ± v e... <br /> BUILDING AREA(if res)lential, new construction, remodel,or addition) T elAk 1" SF <br /> BUILDING TYPE: ' 'SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION- INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 7-0 PictCe .1e ,IAtO fad` ti‘ pCUe(1`490/e <br /> ftt e fevyy no4 5 frac 17 ok) adp05-65 <br /> CONTACT INFORMATION <br /> OWNER NAME: 3 f "J./I-6-0,1 k 0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Li 12_30 3 Ha 1-6 Oar POI Ate 13 I kek #630 3 <br /> CITY STATE t/C)tr4 ZIP qe 275— <br /> OWNER PHONE: 0139 /1L12Ci OWNER EMAIL: efFireyao cxrd_ 1) 0 icau.k <br /> CONTRACTOR NAME: 4;$7) OWN . <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> k <br /> CONTRACTOR PhKACONTRACTOR EMAIL: 4fi V • „, a •vier 4 <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVER T BUSINESS LIC.#(RE Eialji\442/ <br /> PRIMARY CONTACT: 'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTf.CT NAME: CONTACT PHONE: 2_66, z7(.74/4, <br /> -3 e-e4-- 0,\Ictil (7 CONTACT EMAIL: o <br /> S oarca31-rak <br /> a-r-F-reok <br /> AGREEMENT:Thereby certify that I ave r ad and examined this application and know the same to be true and correct. Al!yprovisions of laws nd rdinanc governing this <br /> type of work will be completed whetherl•pe died 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 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 /> • <br /> PERMIT# <br /> E (.0(0 - 203 <br /> Owner/A7111:1-7:47 t Si•Inure Dat- (Revised 10/12/2015) <br />