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t <br /> L-LECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j (E) everetteps©everettwa.gov www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: T`nAnv., V eR0 <br /> ( r () i Fj <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 2ZS 6 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 'g DUPLEX 0 MULTI-FAMILY-#OF UNITS: -Z. 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ©OO, "" <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES NINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C C."7 O -©I <br /> DESCRIPTION OF WORK: k),1i12110 - Re, LA(4 T(/� ( lad pukk.)cEs <br /> 1P 2. FT t c-w"-- W9 PUT UOTS <br /> CONTACT INFORMATION <br /> OWNER NAME: IV O 1S l MA LE5Y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREEW-1, Z(KC , ST. 6 4 S <br /> C tRKLN CITY h STATE W ( ZIP C\b°33 <br /> OWNER PHONE: 2©, , 2226 s---4 OWNER EMAIL: 4�0 t>-(wiet i\ .Coyly. <br /> Y. <br /> CONTRACTOR NAME: 012.,- R-t- �`-( '� (� 5E&v Ic <br /> CONTRACTOR ADDRESS: STREET « ``4- LRT(A W4 �"] <br /> KK\WOOD / CITY STATE VII-SAZIPC‘ 8f- <br /> CONTRACTOR PHONE: O 6 T 3 ct9 C)S CONTRACTOR/ EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 1�S 62:11-} E s S c 1 w,L6, CITY OF EVERETT BUSINESS LIC #(REQUI D) <br /> PRIMARY CONTACT: IVOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:n ) �� CONTACT PHONE: 24(�b 2251 O'6s--4 <br /> tq� 4Te f"VCS-y CONTACT EMAIL: k10T 0 1(, l(�h✓+ <br /> AGREEMENT:T hereby certify that!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 l 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 /> / • ›C r - C'-L� I S <br /> PERMIT# <br /> d2CdP� IV AE <br /> Owner/Authorized Agen Signature Da (Revised 10/12/2015) <br /> CoKTRACZC11r2 <br /> Elt) Ibt o-oo <br />