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ELECTRICAL PERWIT APPLEIC TION <br /> rTT 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@everettwagov! www.everettwagov/permits <br /> F©F Iilf9ATIOG �`:.-.. <br /> lei{�Qdf���<�I�uC�fti� -......... _..;..,.. ..... . . <br /> C � `� <br /> PROJECT ADDRESS: a ` � J �J E <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ,(SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELC ©TRff©Ai: .41tkll©ATNai <br /> • <br /> CONTRACT PRICE OF WORK:$ 70a <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT (if applicable): <br /> DESCRIPTION OF WORK: r° t s:42,e. — JlJe c ) C P, <br /> • <br /> C 1707-M1 <br /> !OWNER NAME: 5 (02 v' o'- -t irJA C ise5 TE ANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET a 5 Oe V.,k -v'c �0 �A`e ucky-ci <br /> CITY I a r) a- STATE C,A zip et/3 e' <br /> / <br /> TOWNER PHONE: 8 . . - gde?_ S 6.V OWNER EMAIL: <br /> (CONTRACTOR NAME: valt►1t� f?�PO v .`cod $eIt-t1tsC_es CC <br /> CONTRACTOR ADDRESS: STREET i g 13 I !LI A(e. S l-- <br /> CITY Ali eki LCA,/ 'T I e STATE 1 A LIP CIS CS' 9- <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC`#(REQUIRED): ���.?„♦jjp 5ctlyNA-t-- CITY OF EVERETT BUSINESS LIC_NREQUIRED)' <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR rot OTHER(Please Specify)-Pek.h V\vi Ge c`cs-11\4— P,M <br /> CONTACT NAME: CONTACT PHONE: CC/ ( g,- 7� 'j- - / 4-7 3 <br /> 6--- 0 . lt? :tq ( [11,6co E^" <br /> AGREEMENT:T hereby certilJ i>l <br /> CONTACT EMAIL: 99 <br /> 1�+�I that I have read and examined this application and know the same to be true and.1c rect 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/am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> ! / <br /> PERMIT# <br /> 97r7d E I 09 - COI <br /> Owner/Aut•o ized Agent Signature Date (Revised 10/12/2015) <br />