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/ ECCTRQCCAL PERMIT AP JCATO•N <br /> f�'"� / 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 ADDRESS: b n t✓i ry Co-1'_ 31 .t* y() - 58 C 0 I E <br /> BUILDING AREA(if residential,new conduction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: El-COMMERCIAL <br /> USE OF BUILDING: C.r� IX ) t n . <br /> • ELECTRICAL APPLICATION IINFMT MAIM <br /> CONTRACT PRICE OF WORK:$ 3 Q lc % <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? 0 YES I2140 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): AU/I- <br /> G DESCRIPTION OF WORK: , ,,,S k- (( yL f- 44 R _ - 1 5 0 I c—F, o 1 rrx_.r x_5 F it nw✓' <br /> e,,--f GUI.'"eL C f9- (.7I C- r V rt 5 1 4vt 5 eLoCg.) 0'4-5,' <br /> 1 Coit r-o / G(s-6 . <br /> 1 <br /> CONTACT INF'� I AT➢ON <br /> OWNER NAME: 13 p ) A.. (or1 ytt -f)J a <br /> TENANT NAME(If Commercial): ,5 N.flit,� <br /> !OWNER MAILING ADDRESS: STREET O G i*A.� i-(C.e 1 J RrL <br /> CITY !/J eiT CAt STATE (N - ZIP '6)O `/ <br /> (OWNER PHONE: OWNER EMAIL: <br /> 1 CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET S 2, O)- 1-,''' S. j 1 <br /> ` CITY 6 U 1.. C 1/ / STATE zip pe3)^)`3 <br /> CONTRACTOR PHONE: D 6 7 )�; )j CONTRACTOR EMAIL: Fri �j rr- p�',,/+,y�}D✓t B 4ie j',,,v17 <br /> CONTRACTOR LIC.#(REQUIRED): pun s 1"b 1 f 1 S WID CITY OF EVERETT BUST ESS LIC.#(REQUIRED): D,�Q/y Z` <br /> PRIMARY CONTACT: ❑OWNER ,ONTRACTOR 0 OTHER(Please Specify) zz <br /> CONTACT NAME: CONTACT PHONE: Q 7 i r`7 - 8 EJ�J <br /> 1a-ci..- F.\ - r— CONTACT EMAIL: 149 r CI C.V.'C. DJiLt, a,/� iJ ., (- '`�i Q <br /> AGREEMENT:T hereby certijte . - -(,L ;� <br /> hat I have read and examined this application and know the same to be true and correct. All proions 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 lam authorized by the owner of this properly 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 /> . * 6S0,® <br /> PERMIT# <br /> O4/,2 <br /> A u zed Agent Signature eDa e (Revised 10/12/2015) <br />