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-,LC CTRICAL PERI 11T APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits • PROJECT M SITE W E ,IIN F a,RN3ATI'i PROJECT ADDRESS: 17 ..a ap - e, 4j . Eve ie-Y( , & V , BUILDING AREA(if residential,new construction,remodel, or addition) 300 SF BUILDING TYPE: ❑SFR-DETACHED lel SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING:1�01 1, ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ C✓ NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES NO ASSOCIATED BUILDING PERMIT#(if applicable):l DESCRIPTION OF WORK: Te(y„ICINNeA1-t SeYvic e 4-kine-AV VI I(1.eAWIe (Wld-4- .v WlO IA).141 4'6+4 61441.0h)i t8'�2►NIDVa✓ ✓�47# c eX.;S1- C.; Oct i.jfrvlA 3 5y el/ ., .. ... ,� : : . : .CON'T'ACT:INF®RMATION. :.:. :.. - - . - OWNER NAME: 5iAU,E)64- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sreeer Sp,�, CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: PD(p less fled r CONTRACTOR ADDRESS: " STREET .3aa3( ~ori Aue, iU ) CITY K STATE I! ZIP CNA'2 CONTRACTOR PHONE: � 708 CONTRACTOR EMAIL: p��*Q� eS (430,100 ,'Lni CONTRACTOR LIC,#(REQUIRED); {Ay L%a gq CITYV\OJF E)/ER T BUSINESS LIC.#(REQUIRED) 511 3 PRIMARY CONTACT: fkl OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2 0C, 7O 3 lOS CONTACT EMAIL: �• rees3Qa y�a,i ,cowl AGREE T.•T h r by certify that I have read and examined this application and know the same b ue correct All proe. ons of laws and ordinances governing this 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 local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC City of Everett Official Use Only FEE -- — - — PERMIT# 1i�/gig E I SO -C13 Owne uthoriz Agen Signature Date (Revised 10/12/2015)