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4rEETT ELECTRICAL 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 <br /> PROJECT ADDRESS: 5.:Sajs '47/,ID,74 4vT:&A 14 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 111 SF <br /> VDUPLEX <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION ' <br /> CONTRACT PRICE OF WORK: $ 66, °6 <br /> NUMBER OF DEVICES(if low voltage): l S i <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: IN CCo�ljj Pb�Lo J.► 1 OM 12OO— <br /> /Aar, ^ <br /> eve 41-,ti 5144417om / r$4,47— <br /> ( <br /> CONTACT;INFORMATION ' <br /> OWNER NAME: I41 If ra v L)4 I 7.—tV l TENANT NAME(If) Li <br /> /� <br /> OWNER MAILING ADDRESS: STREET 54--1 L& tZ'y A (J It `7 _ei A <br /> ern' 5(-Prrrt STATE W c ZIPgr(/0 <br /> OWNER PHONE: 406 %'/ -, 3 d �� OWNER NER EMAIL: r'r,(( /,LJL4 Min , taOln1 <br /> CONTRACTOR NAME: L VCL(�/7..0 `'L„J $?k7& i-1-67k. r-4 A `j <br /> CONTRACTOR ADDRESS: STREET 2!242 PA c-14(...- <br /> CITY <br /> 14(.,`CIN `jU EI•Z STATE WA-. ZIP L$ Zo 1 <br /> CONTRACTOR PHONE: (%f 25--) is-23 it-/-'CONTRACTOR EMAIL: k8 i•i-Q etIsnA/4.1A...% en44- <br /> CONTRACTOR LIC.#(REQUIRED)?VEjl4 S 51Z 12A1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):eiMSS <br /> PRIMARY CONTACT: ❑OWNER pieCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: , tin) -$2 31/(/ <br /> f44&j ,A J CONTACT EMAIL: Kept 6, QSSm Ida. . tt , <br /> AGREEMENT:I hereby certify that 1 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 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> )121.....‘iSill://e IT <br /> —Z3 PERM <br /> I� E 1b( i' M <br /> °1 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />