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'1111PP//41.4C---A <br /> LECTRICAL PERMIT ARLICATION <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: Pit/it/6 FAIT qo-s-$ : kJ L <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: Xpr1'Gove <br /> 1. ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /O, DD o, o!> <br /> NUMBER OF DEVICES(if low voltage):. <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: PLoau li-ia $P6aC 4-7 Ai"- PBw,IFse Levu v.Fa f/t T <br /> P/S e-P4wFGT 7z, /i Dom 9 naZ 3'' "✓ /1A/2> w/A <br /> .:L Gte/bi y 7--gpitY off S5-iE',,BeY <br /> Foit r oG6 rAte7-; w/uc 5E/e-er /c 1c e2o6-570-3e//9 <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Cd,/7?Z es f /•ram G <br /> CONTRACTOR ADDRESS: 0Z/ STREET E , ,ir,,rli2/a. - Ad Ape/ Dor. St9<7"-A- G� <br /> !(/ CITY STATE tv 11?-- ZIP 9tarp-z a <br /> CONTRACTOR PHONE: —74V-3%0— 3 j/5 CONTRACTOR EMAIL: *t'/c aD.iT,v AO , Gdz,., <br /> CONTRACTOR LiC.#(REQUIRED): GdJ✓)772 —06f— 1v? 7 CITY OF EVERETT BUSINESS LIC.#(REQUI ):05"33 97 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: 20 6 -- Cj(D- -t 13 <br /> CONTACT EMAIL: <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 l <br /> comply with the State Contractors Law 18.27 RCW and 296 200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT(# <br /> /07/5/4,/ E lca(2. ✓ DZ(4" <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />