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• <br /> 41/-Pfr- <br /> ELECTr's WM. PERMIT WPLICATIs <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8957 (E)everetteps@everettwa.gov I www.everettwa,gov/permIts <br /> ?SO <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 411 594 Z., <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ;tCOMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION [INFORMATION <br /> CONTRACT PRICE OF WORK: $ c, <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? DYES U NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ) <br /> DESCRIPTION OF WORK: )11:=.7((-, / 12'A'(1)1,./4"(44 <br /> TCL.,e,Ao, fl4-r <br /> , , •• <br /> • •CONTACT INFORMATION • • . , • . , <br /> • •• <br /> OWNER NAME: 4 1,,vi k1‘414.4 rcf TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Lk 3 2 2, P, c <br /> CITY L-7:?:;" STATE (.6,44. ZIP <br /> _ <br /> OWNER PHONE:( 2.,:;:j 3 tr ZC >i OWNER EMAIL: <br /> CONTRACTOR NAME: et) 14-77.;-- 11/4 <br /> CONTRACTOR ADDRESS: STREET 247 0 t71 C214-c, <br /> ory legeri STATE UM— ZfP <br /> CONTRACTOR PHONE( /451 25'1-5)/9 CONTRACTOR EMAIL: )1-. dez e r <br /> CONTRACTOR LIC.#(REQUI RED): 1E2Z(4,15ef 2,0 PA) CITY OF EVERETT BUSINES LIC:#(REQUIRED)4:267Cf6.5 <br /> PRIMARY CONTACT: CI OWNER ffICONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 252.- / <br /> CONTACT EMAIL: t(.2 55/1"7 tClet geirK <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be hue and correct. Al!provisions of taws and ordinances governing We type <br /> of work He 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 I)y the owner of this property to perfonn the work for which application is made and I <br /> comply with the Slate Contractors Lew 18.27 RCW end 288200 WAG. <br /> City of Everett Official Use Only <br /> / PERMIT# <br /> ,•-•'•\_, • I /1 E k <br /> . t <br /> Owner/Authorized Agent Signature Data (Revised 9/23/2016) <br />