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ELECTRIC L PE 'M T APPLOCATQ;-6 <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 J (E)everetteps a©everettwa.gav J www.everettwa,g©v/permits <br /> PROJE T SITE INFORMATION <br /> PROJECT ADDRESS: g 21, jj tiri <br /> BUILDING AREA(If residentlal,new construction,remodel,or a.f Ion) SF <br /> BUILDING TYPE: EI SFR-DETACHED El SFR-ATTACHED D DUPLEX El MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: • <br /> ELECTRICAL APPLICATION INFORMATION <br /> 'CONTRACT PRICE OF WORK:$ J OO tai <br /> NUMBER OF DEVICES(If low voltage): <br /> FIRE ALARM? D YES D NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: OI Stoi-. .412 `c- t t7c.0.,.0‘J(„er �-�1rL *.'e&.' ‘411- Keefe <br /> ti • <br /> • CONTACT INFORMATION <br /> • <br /> OWNER NAME: f IOLJ '' rg•t^t ►LE4- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3.2 21 40 ,� � pp tc�� y <br /> ( ern, t V C.iZ STATE tA.J s S9 XIP i 2- <br /> OWNER PHONE:1I2 ) 32-0"' S3`i�44* OWNER EMAIL: <br /> CONTRACTOR NAME: eb • 1 i 11:. E.. A 4'•' G <br /> CONTRACTOR ADDRESS: STREET ..Z.•1 70 �F1C .-kt G / _ � <br /> cry a STATE Wy, <br /> 'r W((51C( <br /> CONTRACTOR PHONE(C/Z 151-3 'CONTRACTOR EMAIL: ke--A.)' e et..,,Cl3wt._ <br /> CONTRACTOR LIC.#(4REQUIREEF3 I fj CITY OF EVERETT BUSINESS LIC.#(REQUIRED.Nrict <br /> PRIMARY CONTACT: D OWNER W.-CONTRACTOR 0 OTHER(Please Specify) .� <br /> CONTACT NAME: CONTACT PHONE: L.f . 152 - //t/- <br /> WA CONTACT EMAIL: f< �5 �t <br /> Zregf <br /> AGREEMENT 1 hereby codify that 1 have read and examined this appfcation and know the same to be Imo 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 peril*does not presume to glee authority to violate or cancel the provlslnne of any other state or <br /> local law regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application Is made and t <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Etito-a205 <br /> Owner/Authorized Agent Signature Date (Revised 9/232016) ��- <br /> 1 <br />