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ECCTRICCAL PERMIT AN 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 J vwvw.everettwa.gov/permits <br /> PR 4E T:SITE I IF o E 6 3AT'ION <br /> PROJECT ADDRESS: 47 I./i1 A-' <br /> BUILDING AREA(if residential,new construction,remodel, or addition) —7 0 SF <br /> BUILDING TYPE:X SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: , <br /> IELECT tICAL APPLICATION INFORMATION _ <br /> CONTRACT PRICE OF WORK:$ 3j�o0 Q <br /> NUMBER OF DEVICES(if low voltage): /2- <br /> FIRE ALARM? ❑YES JEINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ('/go/- 00 3 <br /> DESCRIPTION OF WORK: 'op 70 SP EY 4' u'/ru„ SPG <br /> /&STiQ(.L/�I• ¢ /l to"-v Sr. lil G f Ahl C.- -*. ,-- -f L..'/77-6 a'v7'L Ci S <br /> L I Cn tk,_ � Vie'. <br /> A MsCi1Va. <br /> CO.,,T1#C ' <br /> N. ..,.:, T:INFORMATION,::..:: :.. - - <br /> OWNER NAME: �1:-,-A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /bp/ <br /> CITY STATE (,V Q• ZIP <br /> OWNER PHONE: z/Zj—.5P4---row <br /> . % b3 µ OWNER EMAIL: zc�pc-e h G04..z I. CovtA <br /> CONTRACTOR NAME: --ow q�q/ 0�,(, ! �1 <br /> CONTRACTOR ADDRESS: STREET <br /> Cir' 5,-,-.4-1-rt STATE S ZIP"/� 9Z5 <br /> CONTRACTOR PHONE: c CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED)• - 1CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: S OWNER . 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 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 lam 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 /> Or9 <br /> PERMIT# <br /> '.1 1 A E ( O '7— O cfg. <br /> Owner/Au; il`rt Signature late (Revised 10/12/2015) <br />