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ELECTRICAL PERP T .M_ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 J (E) everetteps@everettwa.gov J www.everettwa.govlpermits <br /> PR 4J C 'SITE INFORM, TI®N':: .. <br /> PROJECT ADDRESS: 7C.6 16 rid" 1/EXE:l7` <br /> BUILDING AREA(if residential,new construction, -mod-', or addition)_iofv./C-0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED ElSFR ATTACHED YDS DUPLEX 0 MULTI-FAMILY-#OF UNITS: / 0 COMMERCIAL <br /> ;USE OF BUILDING: f 774- • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ `7 D O Q <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 12/NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: l PIr ®dip) Igo exrr/�`lCfrc' <br /> Box /1. S Pdss r afro 61,11 <br /> 2,P, e-f ✓' ( f oj/i �.�- rel✓ 't.s �z�� �� C�n� <br /> AAA ? V ,�f '! 5��,•� C c-e71/),v(C7 7 vZttAri s . <br /> ::: .C...._ .: ..o- ... FORM . . _ . _. . <br /> -: � � :. � ....:®NYA 'I' IN.,.._�R...=AT10N�::.._ • - <br /> OWNER NAME: ;67/00-6e /two'.fr NT NAME(If Commercial): �7 2 <br /> OWNER MAILING ADDRESS: srResr e . gi " //(o'b- l �� . ✓to j <br /> CITY Z[/��. STATE �%(//fi, ZIP /gZ6 <br /> OWNER PHONE: ./—`�3 3� e7 OWNER EMAIL: <br /> CONTRACTOR NAME: V Alt'CJ <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIF <br /> -I <br /> CONTRACTOR PHONE CONTRACTOR EMAIL: — _ _ _ <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): v <br /> PRIMARY CONTACT: ❑OWNERCONTRACTOR 0 OTHER(Please Specify) <br /> SCO ACT NAME).--1CONTACT PHONE: l 373-�g t 3 <br /> ade ,Gz CONTACT EMAIL: B&4k fgC a)ki <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 lam authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> I FEE <br /> l _ <br /> PERMIT# <br /> Z 26 '7 E �� 1�r \V <br /> •er/A orize. �Signature Da j (Revised 10/12/2015) <br />