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ECTRICAL PERMIT Al LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: I " % -> I ; i"i, II ‘11 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: S de..01 4-(c. 1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ _7_ <br /> '.-j>t <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ,,NO <br /> r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: l` oa/v I Pl e fb V O i � c__ v if7 7*`--rG C t i ✓- /T1✓ec k . <br /> Li I)4- 15c,c.k- at bre,. 162_ r ,A., to OA— -Ia ,'"-, PA "9. / _ NI n <br /> r-i'''.-•_.5 . (rc ; f e_ rv/o✓, IA, r r vt <br /> CONTACT INFORMATION <br /> OWNER NAME: , ',c. I g(-a f/7 aed TENANT NAME(If STREET A- V' <br /> Commercial)) I t ' <br /> OWNER MAILING ADDRESS: STREET 11.2‘0-3 13n- C.. 1, / � /µ/ 7S�} t. <br /> ZO <br /> CRY STATE ZP <br /> OWNER PHONE: YTis7—2 3 / -g6 f g OWNER EMAIL: /G Sort L 98O, 7 e it atr is i/. Co el-i <br /> CONTRACTOR NAME: „Si,rVer5 y ..5y S€-G' --j /rim (flii L G .1...9¢. ) <br /> CONTRACTOR ADDRESS: STREET y.5 /( z,,,., r �4 1 N to <br /> crrY �j c'c rii..-rc-- /STATE u ZP 92/ a •7 <br /> CONTRACTOR PHONE: ZO G` 5-71 - Y7L is CONTRACTOR EMAIL: j o n1.t1 St,t n 02.1--5 y S y$ t¢.v1 S. C o ,i-i <br /> CONTRACTOR LIC.#(REQUIRED): ;1r,f'Q.r"5 iy o5 6 `' CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(")t:,( 5��f <br /> PRIMARY CONTACT: ❑ OWNER gs CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 204._5 7i - `f 7 E <br /> JI; ..-i 1---_- r , _ 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 progorls 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 /vim <br /> i <br /> PERMIT# <br /> i r6 E I (0( - bI (1— <br /> Owne utitirrt Signature <br /> ("ia/ (Revised 10/12/2015) <br /> 0 i <br />