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'11:4:/-7--a <br /> ECTRICAL PERMIT AF _ICATION <br /> - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 ( FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ®® <br /> PROJECT <br /> MA <br /> SITE'INFORMATION <br /> PROJECT ADDRESS:U I t l J f 1(ek .i ii'i/ ,--1::ivN <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: [COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /0 j) <br /> NUMBER OF DEVICES (if low voltage): I <br /> FIRE ALARM? ❑YES ANO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: <br /> I S J- 61 /A3 5A- . <br /> CONTACT INFORMATION <br /> OWNER NAME: - t• ' C.-- 01 it o „. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET(i! 01 / SC t 1!Jett 6/vs/ -/ 0i <br /> CITY (" Ile„.1/-'elt:/- STATE (AM yp ZIP �/ <br /> OWNER PHONE: OWNERyyEMAIL: <br /> CONTRACTOR NAME: /( .c)(71/1 S� ,c Z(PLC <br /> CONTRACTOR ADDRESS: STREET C,, - (//S, /2/ <br /> CITY il' V-*4 STATE ZIPIT <br /> CONTRACTOR PHONE:'—i t-- A , obi/CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): PC-{,/(/ de L.. .:(7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): wt1-7 k2 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:, \; CONTACT PHONE: 4t7f bj, TfJL/ <br /> � �� "f-Q C ' 1/6CONTACT EMAIL: t� - /'./ ,` Yip/S°gfr y, 7.ef ,i <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 laWsI and ordinances governing this <br /> type of work wilt 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 /> PERMIT# <br /> i,Ower <br /> ( E1a0 — bt3 <br /> Uth ized Agent Signature at Revised 10/12/2015 <br /> ( ) <br />