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477 ELECTRICAL PERMIT AP1LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: I of Q ID� Ru % U <br /> BUILDING AREA(if residential,new construction, remodel,or addition) IaOLJ SF <br /> BUILDING TYPE: 114 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Re c a i ct L <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ LQQQ 4 CO <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES liCNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1 n <br /> DESCRIPTION OF WORK: 3 0 5 SF 1' t T'i171(� .1 0tO t 51P Kele C, <br /> I3 u°.G.) oo Arnp <br /> CONTACT INFORMATION <br /> OWNER NAME: Geri`;-i• Veinsi-r OL' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Iaaa C 4T' 'e• <br /> CITY t er J STATE Di121 ZIP al' aO1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: p `�/�Q`('I-flCe etec tcz <br /> CONTRACTOR ADDRESS: STREET--"r 01 a --and P1 P31AD <br /> CITY ,r1tA) STATE ZIP Qaci <br /> CONTRACTOR PHONE:3( 0-s-]a-Listsp1 CONTRACTOR EMAIL:Per'401-vsci.nce"elect-ri(CetA .- .)e <br /> caible.coin <br /> CONTRACTOR LIC.#(REQUIRED):f c 12J E1 otos CITY OF EVERETT BUSINESS LIC.#(REQUIRED): pya -111. <br /> PRIMARY CONTACT: - JWNERCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: c CONTACT PHONE: 300-6"-(,Q.-i 1.09Y✓- VJ O t€. J� \ CONTACT EMAIL:Leer .'C Y I.1Ce£.( )C Low- '-CQC e• <br /> AGREEMENT:I 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 LYAe'rn <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 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 1LLcth2orn f 1-*15-)E E ISl1-- 13 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />