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LECTR CAL PERWLT A IJCAT4ON <br /> CITY OF EVERETT PERMIT SERVICES J—� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 C 1663.O6q <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps cr everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: e <br /> ,pCl ` <br /> BUILDING AR i ikew construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX I;iMULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: /'y > t ,v <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 7i QC/0 � U <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES *10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): — <br /> DESCRIPTION OF WORK: _Z05 ?UinJ (2) ZQ %Iev+ f5 7/r��f 71-tre,3eJ )15 <br /> 1 <br /> q D G <br /> 1 <br /> CONTACT INFORMATION <br /> OWNER NAME: I TENANT NAME(If Commercial): L114)J 9 0 P <br /> d r2 Q <br /> OWNER MAILING ADDRESS: STREET q 0 0 /Z 4 J41- fi v e \nl <br /> cry a Vere -S t STATE 1-41.09 ZIP 'f 26`J <br /> OWNER PHONE2-53 -Sd �- 77 20 . ...OWNER EMAIL:... ,.�...._.._. . . .: , .....�.. ... . ....... ...w....... ... .z_... _._ <br /> CONTRACTOR NAME: S M 5 %el tc-' of S e 44 e <br /> v <br /> CONTRACTOR ADDRESS: STREET 2.8 /Pap h( P1. 5 ' <br /> Crl [� <br /> y c STATE w/7--- zip ci ei y <br /> CONTRACTOR PHONE: 26 to-7 a 3— 3a2,4 CONTRACTOR EMAIL: SE A N M q SM CIN COFS £A TT L E•c <br /> CONTRACTOR LIC.#(REQUIRED): SM t 1.15)(O1o(o D CITY OF EVERETT BUSINESS LIC.#(REQUIRED): d 3 d 2 d 8 <br /> PRIMARY CONTACT: 0 OWNER IT-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2-6 - 39 L- d 2 4 <br /> , CONTACT EMAIL: 6,X 4R N.)3(T - 6 e.3 y <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 /> # 161 t5I- <br /> PERMIT# <br /> 011"111" <br /> / 3 i`1/�eo F \ O D5( <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />