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f ELECTRICAL PERMIT APPLICATION <br /> CITY 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.everettwagov/permits <br /> re`Qa.`lTll®.i1� <br /> PROJECT ADDRESS: g d t " 0:2_1,-(A, St-- t_- , <br /> .BUILDING AREA(if residential,new construction,remodel,or addition) SF ' <br /> BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> • :.. Ebb <br /> �Tr�11t-;.L. ;l3PL9�r=,T!l®ki'_[dli40®f- 'Ai'[ILQ1A4.. . .._..:........ :. ...................... . ..... .... <br /> CONTRACT PRICE OF WORK:$ 70 C <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT (if applicable): <br /> DESCRIPTION OF WORK: o t)• Ye — t" - -ue-)t i.. u•- e, <br /> 8ti\cw reit4 -- # CE '747-0 [ 7 . <br /> OWNER NAME: 5 i t Oe Y• E cA-V�.L° — \OØ45 T& NT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 `i S $ Oe U U-trek ID d`•.k-`e UCkard <br /> crrY I C'i�.r-.200i,-0..... STATE C A ZIP 7-/3 5`‘ <br /> OWNER PHONE: ,.. r g/ff Q C7—b,CC° OWNER EMAIL: <br /> CONTRACTOR NAME: 1I_,& i A il{-) e ec k-sr t'1/4c:eJ Se 6r'u t C_e S C 0 <br /> CONTRACTOR ADDRESS: STREET sCf`1$ 13 Cf I A CJe S ( Q C� <br /> CITY A tik) Lc> I <br /> 4- e STATE A ZIP (1L, 615 l <br /> !CONTRACTOR PHONE: ,, y CONTRACTOR EMAIL: kik <br /> CONTRACTOR LIC.#(REQUIRED) A.N � r\JE USINESS LIC.#(REQUIRED)ry _ W <br /> F EVERETT B _ ri <br /> y� u.� <br /> G PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR BOTHER(Please Specify) tck r v' 1 Ge co t 14''` 1". <br /> f CONTACT NAME: CONTACT PHONE: CT i g)- 7'11-- J - ' 3 <br /> ` CONTACT EMAIL: " <br /> AGREEMENT:T hereby certi that I have read and examined this application and know the same to be true andlmfrect All provisions of laws 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 1 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 /> 2(1c .„. <br /> _ , .. <br /> PERMIT# <br /> 4,,,,,v, 9/ t/d E 1 Zo9 - CA 1 <br /> Owner/Aut.0Ized Agent Signature <br /> � Date (Revised 10/12/2015) <br />