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EEC CTRIC AL PER] TIT Q. !UCAT ON <br /> ->-i� 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 /> P I'OJIECT SITE I INIFORG 3ATIIOW <br /> PROJECT ADDRESS: /y/b di7G/hVL, <br /> BUILDING AREA(if residential,new construction,remodel, or addition) */ /Z# SF (,�G <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ,DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: ? <br /> [ELECTRIC;L APPLICATION MATRON <br /> CONTRACT PRICE OF WORK: $ �--- <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 4-7g>zc_44 H <br /> f .� f 2 �u��•� �j7(/�G / <br /> / ✓V 7-0 �u!2 tI /9 LI S,e;J lad•, 2c 0.1,0041> <br /> v\ I 1 CP oo$ <br /> INTACT INF,•RMATIION <br /> OWNER NAME: Z/Y / - TENANT NAME(If Commercial): /77j'7i , 4' <br /> OWNER MAILING ADDRESS: STREET <br /> cn � i,� 1 7 STATE Y>A�,J - ZIP ?,�,/ <br /> OWNER PHONE: L/Z�- y(�//JJ. �07 OWNER EMAIL: //G y�U �yj _ de <br /> CONTRACTOR NAME: A7/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR -OTHER(Please Specify) /D0,37 -- <br /> CONTACT NAME: CONTACT PHONE: L�2�,23 '/ - <br /> iryo- --v- CONTACT EMAIL: r <br /> ► r v five ,eQ <br /> AGREEMENT.-T hereby certify that I have read and examined this application and know the same to be true and correct All provisions oflaws 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 l 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 /> lk <br /> PERMIT# <br /> 4141, r— \lk) 1 \ 6 0(A <br /> / 7 <br /> Owne'Authori .d Agent Signature Date (Revised 10/12/2015) <br />