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t r p,J r/J *MI IC IIfr i.,ut:IvlM I I ,I111 <br /> PROJECT ADDRESS:1 5 q , _ S`-E_ , -\.tit. °t4 , t�{ -1- <br /> BUILDING AREA(if residential,(tew construction remodel,or addition) ‘` SF <br /> BUILDING TYPE: ❑SFR-DETACHED [ FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: '\l ; y\ �j� , <br /> l ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ \O} Q.3.) • JCS <br /> NUMBER OF DEVICES(if low voltage): LA n ,/ <br /> FIRE ALARM? 0 YES �}-NO r[l/,1��J-, 1 � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: \, It \ V\91 22‘t() } \A .. <br /> CONTACT INFORMATION <br /> OWNER NAME: —7 . Q \� 4,UY ,�<-I-A d \ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sreef .2)Lrk j1\ 1-2_,q t ? '3 c E✓c <br /> CITYr .\O. 'c- y\ STATE \V ZIP 9t <br /> OWNER PHONE: 3'' n .,- -y '�0:4 1 :T OWNER EMAIL _, ('GA,�`A I \\ ,K <br /> CONTRACTOR NAME:: f,fir r LU... .1 '/ 1, - t, <br /> CONTRACTOR ADDRESS: STREET \ l ut k�Ls'' cAl v\14 01,10, <br /> CITY 444? l 1� S STATE .. ZIPP 1 I <br /> CONTRACTOR PHONE -j''314.- CONTRACTOR EMAIL: ;@ "`4 ? } k u.Qt."ty��C tq{ 31 iL L.,C o(1 <br /> '� <br /> CONTRACTOR LIC.#(REQUIRED):1)„ ! 1 I t) i CITY OF EVERETT BUSINESS LIC.#(REQUIRED)s (" -IRb <br /> PRIMARY CONTACT: 0 OWNER 1 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:L4.7 <-'" '°'"t,i, 7,05 <br /> k\Oi;V\C.LV\ a CONTACT EMAIL. ri 4 � > eeirn <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with Me State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> `;, C?_ E,' �, � ))- ) E 1 12— ON- <br /> , <br /> Id L <br /> Authorized Agent Signature Date {Revised 92312016) <br />