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410 <br /> ELECTRIGAW <br /> 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 ! www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3121 T V 1-/ --I? AV F- = f <br /> BUILDING AREA(if residential,new construction, remodel, or addition) 2 00 — SF ZS <br /> BUILDING TYPE: ❑ SFR-DETACHED C�SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ )2� ,Spp <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES [516 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C/ (0 / O — COS <br /> DESCRIPTION OF WORK: Fi Ml-cAt) 09DO f riO.v A,JA /,V S7-A1/ AU6it.() <6.R.v/C.E <br /> 2P0Ai P <br /> • <br /> CONTACT INFORMATION. <br /> OWNER NAME: b 0 -I- ,S Fc.FF 'kTS O A.) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rasEr 3�Z j TU LI\LI P <br /> crry /,VF.f2- 1 J STATE EAj A ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: READL a- 1-CT k I L LA_ (-- <br /> CONTRACTOR ADDRESS: STREET ?O A�,)( <br /> cmi' O'_\I5 STATE IAA- ZIP 4 Z? / <br /> CONTRACTOR PHONE: N 2S-3' O-Se 6 7 ICONTRACTOR EMAIL:,- '1Zi P sk,k L.6 .L Fi.0 T K)C--- „ <br /> CONTRACTOR LIC.#(REQUIRED) RAISi—r:-t_9(o g J E CITY OF EVERETT BUSINESS LIC.#(R CUIRED) <br /> PRIMARY CONTACT: ❑OWNER IP'EONTRACTOR 0 OTHER(Please Specify) ` <br /> CONTACT NAME: 3fiikp FORS TI CONTACT PHONE: 1125 230 ._S6 G. -7 <br /> CONTACT EMAIL: ,J Cam' grAbL-li r jzL&.G7 R) C_ LL ,At.flt,— <br /> AGREEMENT T hereby certify that/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 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 0...CDC) <br /> PERMIT# <br /> j2_13_/ 7 F V 00 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />