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ELECTRICAL PERMIT AliTLICATION �►� CITY OF EVERETT PERMIT I DICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov J www.everettwa.gov/permits • PROJECT SITE INFORMATION PROJECT ADDRESS: j t e-t•JOti' 0 (' 1P1j ^ BUILDING AREA(if residential, new construction,remodel,or addition) SF A t e .1 BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ )21S—p� NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES .)!1•140 ASSOCIATED BUILDING PERMIT#(if applicable): I v 0 (,, DESCRIPTION OF WORK: kite_ " Z s fav+ (s -r-d 1'U1°',�' �e... 41-4- - 1 2 )aI,s MIP. . i Id;fr - CONTACT INFORMATION OWNER NAME: (k.Gd� 1 -ew t `- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET tS DO (zo o � w� i S J- _ ;03 ?Ai C 3 1 1/14.11 Com"~ CIN p- -' STATE I IC Z- ZIP OWNER PHONE: "I Z 5 2 SSS 7� � OWNER EMAIL: C lu � - °3 '`�+^�M�,t c` . (0 CONTRACTOR NAME: CO I v v �L`'G n�� {J tL —�C CONTRACTOR ADDRESS: STREET •�• 30 X2 6 [ `� �� ZO C 4 s'' E 4 v.. L cny L c- . STATE � V ZIP CONTRACTOR PHONE: `gyp/ a Z Z cc/S-7 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CG vv‘ �L .$ �� i-S( CITY OF EVERETT BUSINESS LIC.#(REQUIRED):013120---- PRIMARY CONTACT: 0 OWNER�... CONTRACTOR 0 OTHER(Please Specify) w�� ....�....:__w.,,.�.._�Ak..�,..,....�.a........._.�,.W.w....�.....�....� CONTACT NAME: CONTACT PHONE: 7 oC L{'2-'Z (C c� k ‘. .11/10 CONTACT EMAIL: 6 GC 1r) ' y •--N- AGREEMEAfT.•T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws V d ordinances governing this 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE \, e 1 1 PERMIT# E ) X02BIZ Owner/Authorized Agent Signature,' Date (Revised 10/12/2015)