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kLECTRICAL PERMIT All LICATION <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 /> . ...: .. ... ... .... <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 667/6 G 44-6w.,41 77c---)e <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ LI&© -OO <br /> NUMBER OF DEVICES(if low voltage):. <br /> FIRE ALARM? ❑YES IFNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: S(e U(6(5 (� s 7 D,) ---z6CJ <br /> CONTACT INFORMATION. <br /> OWNER NAME: ( 111 e)(9 (6.= pelt-i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6 /'61 Gr > Ote <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C0,149.4 EIS f YC'G <br /> CONTRACTOR ADDRESS: STREET <br /> CITY <br /> /�/�y STATE ZIP <br /> CONTRACTOR PHONE: 2 9 !6-© `Z b 77 CONT CTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 1..,(Ag. T 561 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):c'3SDg <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1/7„,.. -.7‘0.. `g'52-- . <br /> .. -Jar fes) Clack, 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 t 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 /> Do Di <br /> PERMIT# <br /> �•�- / 4s z 10(Q- 1 (0(-.1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />