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Aff4,-. ECTRICAL PERMIT API`LI ATION <br /> .4'/►', a CITY OF EVERE i PERMIT SERVICES <br /> ‘ � 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 { FAX 425-257-8857 1(E)everettepa everettwa.gov www.everettwa.govtperrnits <br /> PROJECT SITE HtWoRhuvriort <br /> PROTECT ADDRESS: 2. 2I c:01.12y. ece <br /> BUILDING AREA(if residential,new construction,,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-tTTAC.HEO 0 DUPLEX EX ©MULTI-FAMILY #OF UNITS: gir6OMMERCIAL <br /> USE OF BUILDING: 0 c.c. B,_ <br /> ELECTRICAL AII'II IOAT1O!INFORMATION <br /> CONTRACT PRICE OF WORK:$ .' 00 ez <br /> NUMBER OF DEVICES(if law voltage): /t <br /> FIRE ALARM? 0 YES IfeNQ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Cir./ /02 v 2.4ll i;a1 far reoce,0 co,r4 /,,spoieri <br /> '• {t <br /> CONTACT INFORMATION <br /> OWNER NAME: kol-da ieepr - t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s 'Colby, ATI/ e- 1 <br /> crry t r _STATE ZWiT02 <br /> 06 <br /> OWNER PHONE: ,; -S?"00 OWNER MAR: + DO''. r$odwt`at/. <br /> CONTRACTOR NAME: - + h,C Ilil///1/A4 `,n`' <br /> CONTRACTOR ADDRESS: STREET (¢1 r <br /> COY STATE ZIP <br /> CONTRACTOR PHONE: O - v3o 7.2 .% CONTRACTOR EAAAIL:.. f- .. .0 1,704.4e, tf r� . <br /> CONTRACTOR UC.#(REQUIRED): E.CC.O 1"\' I l tt5 g crlY OF EVERETT BUSINESS LIC.*REQUIRED): 6 51 i1'. <br /> PRIMARY CONTACT: 0 OWNER WCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 476."' .. . <br /> Sea CONTACT EMAIL:; <br /> AGREEMENT:Thereby certify that(have Lead and ensnared this application and know the sameto be true and correct. AU of lows and or/Mamas governing this <br /> type;of work wit be coripletsd whether specified herein or not The granting of penult 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 ant authorized by the owner ofthts property to perfcam the work for which application is made and <br /> comply with the State COnhac t rsLaw 18.27 ROM and 296.200 WAG <br /> City of Everett Official Use Only <br /> FEE <br /> Lr) 6-(1 yrs 1► �t4 egI� <br /> � Gbh <br /> PERMIT# <br /> \91/ A See- Di/-/-A-" E 1301'-- <br /> Qylalerl� /Igent She Date (Revised 10/12/2015) <br />