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ELECTRICAL PERMIT APOLICATION <br /> NIIIIICITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: i O S Pi (1-e_ 4.. EVQfe-1-4- t'' <br /> BUILDING AREA(if residential,new construction, emodel,or additio SF • ''ll <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTAC UPLEX 0 MULTI-FAMILY-#OF UNITS: ®COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ l c- 0 C)-0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO /� i <br /> l <br /> ASSOCIATED BUILDING PERMIT#(if applicable):1 V 7 12- Q l t• <br /> DESCRIPTION OF WORK: Pkvn e ) (-) S Co b I Q � dG,, f i n a- <br /> CONTACT INFORMATION <br /> OWNER NAME: POlt cati (tC'.s_ IYll/- COTENANT NAME(If Commercial): SQ.-1 -3 A/ A. <br /> OWNER MAILING ADDRESS: STREET I 1 1_ dV. ( m 01 QrC;b4 S)- . <(/'1 i e- 16" <br /> "i—e'S'i7st-tY, CITY (' eic r(19 inart STATE "v 1 ZIP I)722.1... <br /> OWNER PHONE: Sha (1,0`2,---12 55 OWNER EMAIL: S efs� <br /> S1 t 1 .fl(i��marl 4-S - /Pt• <br /> CONTRACTOR NAME: S SC v) /fit n 4.. . . . ,. II ., <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: ¶6 0 2- 1 ZS-5 CONTRACTOR EMAIL: . <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER D CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (2j 6 o) 24:72 [ Z s g <br /> S .SSS-) I/ t'(I CONTACT EMAIL: S€(•ice KO((„,dt daril(,,,244-0.1. 4$$ 4,,,t,,, <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 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 WAG. <br /> City of Everett Official Use Only <br /> FEE <br /> 5V, 0O <br /> PERMIT# <br /> 1 , ) +: iy. Etgot- ltZ <br /> Owner/Authori Agent Signature Date (Revised 10/12/2015) <br />