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ELECTRICAL PERMIT4LICATI®IV 77 <br /> CITY OF EVERETT PERMIT I ICES <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: 110/0 �:.At�140A <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF /�- ,t e 9 '"'L <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX Sf MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2JQ&, <br /> cs- <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES $NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1\.)0 ``__� ( <br /> DESCRIPTION OF WORK: C Q, N z :,$6.0 1Jaw g �U mO0A �le...I�tr- <br /> 2 )(Kitts s i,o I <br /> • - CONTACT INFORMATION .: <br /> OWNER NAME: c..ti.NA l-/-CO 1 44' TENANT NAME(If Commercial): 7 <br /> OWNER MAILING/ ADDRESS: STREET 1 !-f3 00 �'Jo t C c erSr ) S-1.1 ;03 ? 1 C 3 1! <br /> (•-(f' C��p�'t� cnY `�J . STATE '56) Z- ZIP <br /> 12 <br /> OWNER PHONE: " g 2.SS r 031 OWNER EMAIL: C -� l� "tx4�f-"'`G^� � c. • ell <br /> CONTRACTOR NAME: C0 `Al e�v u4J l c "�I`�� — am V t-L U_ C <br /> CONTRACTOR ADDRESS: STREET r•ID• 30 x C-2'` '� -71 Zv 7 ex c <br /> �j✓w i'� CITY W a- • STATE 41 etcZ C) ZIP <br /> CONTRACTOR PHONE: 7106 ZZ. (6(5'7 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): Cd PL- ES Gi `v CITY OF EVERETT BUSINESS LIC.#(REQUIRED):054 3B1 <br /> ...,L <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) �w,T•��'.-zM- V,!-`VN,..w..�..,�._.�._...-�.a,......,_....�._...._..�.....�-' <br /> CONTACT NAME: CONTACT PHONE: 7 OC L f 2-Z '4 S <br /> 1 ` O( CONTACT EMAIL: Nt [� r G a � e crho� . Co <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 lawsSind 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 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 /> FEE <br /> • 4 <br /> l <br /> t <br /> PERMIT# <br /> ' c>2 • 6 0 E (got' 03 <br /> Owner/Authorized Agent Signature,' 6ate (Revised 10/12/2015) <br />