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457r •ECTRICAL PERMIT A•LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 0 t y o f v,1, 14 /t <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> 1.USE OF BUILDING: -eyy)/le,,,, \\ <br /> (ELECTRCAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ '/5,vw <br /> NUMBER OF DEVICES (if low volta e): A/ <br /> FIRE ALARM? ❑ YES <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 71n5 }77,/ Pam --0-. /i, ievoin_ 4:cr.P <br /> CONTACT INFORMATION a <br /> OWNER NAME: f? ,..._,,,/ 5,,//1' gp TENANT NAME(If Commercial): J rp.. ,b//i/l�j/,_ <br /> OWNER MAILING ADDRESS: STREET / L1 /)Q yvl'# /fit �[ <br /> CITY li 144 e p_ STATE ZIP f p 10.3 <br /> OWNER PHONE: t4 is- 3 Z.7- 9 L1Li f OWNER EMAIL: <br /> CONTRACTOR NAME: Vol/,eAl it he eJ(`,c <br /> CONTRACTOR ADDRESS: STREIT 1100 Ole/roll C.r«/e O rqe <br /> CITY C✓&I,e fi- STATE 1/N44 ZIT413 _ <br /> CONTRACTOR PHONE:LaCo)-Of--3 Z CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): v pc L Fc P /y, avtl- CITY OF EVERETT BUSINESS LIC.#(REQUIRED)• 01Zs5.6 I <br /> PRIMARY CONTACT: ❑ OWNER rkCONTRACTOR ❑ OTHER (Please Specify) `' <br /> CONTACT NAME: CONTACT PHONE: L/ 2,v-- ? Z 2 - 71.,', © / <br /> ,S'e.0, -- 016 y CONTACT EMAIL: S +o, -,77{, 1 .ie ' <br /> � � cam-• <br /> AGREEMENT::T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <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 the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> .3 2S" ,..------ <br /> '-'N. j714/) / <br /> PERMIT <br /> .i�� r�) � E 2.0 <br /> 0 er/Aylhorized Agent Signature ` U to (Revised 10/12/2015) <br />