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4tETT ELECTRICAL PERMIT 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 vvww.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 2° cS 0.%.-1 6 sl\I BUILDING AREA(ifyesidential, new construction, remodel,or addition) SF BUILDING TYPE://' SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: 2e5-s\--l c 1 a--C. ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ DOD,DU NUMBER OF DEVICES (if low voltag FIRE ALARM? ❑YES v1 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 20© a-rr� a,ri Ci-' �- C,c.2 .0 p C�aI�J M `St117em YZ Ex. 3 16 G,rn d1 S o5 . (rtf,-i`. CONTACT INFORMATION OWNER NAME: r A("\a. LargVil TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 120 5 ,o St (( A CITY i eji STATE zip cr 0,,2U OWNER PHONE: p 25 - 51 0-i\.. --706i OWNER EMAIL: SV ai dCJC 2_,(7Og62 ('1u e I .Corr CONTRACTOR NAME: ,... ea-1-6t4)(1 SCC.--T Y C or D- CONTRACTOR ADDRESS: STREET (3f31, L f O a Cies CITY STATE V V A ZIP q 0I CONTRACTOR PHONE:9gs- gO5- 3( 9 O CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): SATO F(jG Q V(DO I`-6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)b5:1 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR El OTHER(Please Specify) CON ACT NAME: --' CONTACT PHONE: n okv-• ( q �� CONTACT EMAIL: O �1` ea Inaej /i. c,C0✓1/I AGREEMENT:I her�"y certify that I have read and examined this application and know the same to be true a cor>ect. All provisions of laws and ordinances governingr / this type of work will be corns ted whether specified herein or not. The granting of a permit does not presume to give thority 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. • 40° 4 City of Everett Official Use Only 0,, PERMIT# ` ,' 9/1/(0, o ' r � I/ o E1 OS- j2 Ow -r/Authori1 -.'Agent gnature Date/ (Revised 9/23/2016)