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4E7 <br /> !LECTRICAL PERMIT AP 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: Y 3 W Qc s c o c,r1 z.:N.d-Pa) 1-)o- 5 3 C (. m € • S <br /> BUILDING AREA(if residential,new construction, remodel, or addition) 4/0- S o SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: cin COMMERCIAL <br /> USE OF BUILDING: \Jam mac ()Q ^ 5 U 64,bG. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 1 p 1 d v 4' 'f <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0'NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: -4-1•- - NI)Cj PsO c7 Mp L13O v <br /> CONTACT INFORMATION <br /> OWNER NAME: %CG.7) I\;j. r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 57j 7�'� S 2 ),,T, <br /> STATE A, ZIP Q\3 LY <br /> OWNER PHONE: Liz‹, qS44- aj3S OWNER EMAIL: hS-Q.Z)l.;5c s Q '(hS N •C wrN <br /> CONTRACTOR NAME:\N) ccr,V12_�1r�v5).6(..) <br /> CONTRACTOR ADDRESS: STREET '&\?p, QD 3 7 (,i l <br /> CITY CLva_l_a_ STATE �1 ` ZIP a2D <br /> CONTRACTOR PHONE:�12,�- sy - -� 5u CONTRACTOR EMAIL: 1.3S'01 ; jet0 IrOST-) .0 <br /> CONTRACTOR LIC.#(REQUIRED) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: EA,OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 OZo ) <br /> CONTACT EMAIL: I- <br /> OC(r� L�Sv 1 (rS ,C, <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 /> 25D <br /> PERMIT# <br /> )z, E t, Cc --- OS <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />