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_ECTRICAL PERMIT 'LIGATION <br /> /11111 :4 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 `j -is -1 <br /> (P)425-257-8810 I FAX 425-257-8857 ] (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4—/ (Cil <br /> BUILDING AREA(if residential, new construction, remodel, or addition) Z. --Fro+ SF <br /> BUILDING TYPE: IAFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: k 17'ENT ACL_ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ e)0'276O• <br /> NUMBER OF DEVICES (if low voltage): t Z• <br /> FIRE ALARM? 0 YES I NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): tt <br /> DESCRIPTION OF WORK: p 2-00 Awt p toGt[�1 G I. L�1,Gtil.t <br /> CC 1 (/{ 7 <br /> I <br /> vu (/-.i-1--e>k-ec.\ <br /> CONTACT INFORMATION <br /> OWNER NAME: 0 R..�jA-til �Q 2 l RZt.Lr ,`r 1=i: (TLC <br /> N NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I to d •2--15+1A-` I <br /> �'jT /� ,r <br /> CITY U V Z Dt j V I W STATE WA ZIP 96e-7 72_ <br /> OWNER PHONE k-2-S- 2J I Q 7 OWNER EMAIL: L. rlxz1lSe1Lc y'-e-IL-LC YVIG(► t i C.a <br /> { <br /> CONTRACTOR NAME: U $ ei4 ) l 4-to U_C, <br /> CONTRACTOR ADDRESS: STREET L(-y -7 0e 1�+� <br /> CITY WO(/ {4 V t �" div STATE 04 ZIP "L <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: Ctv'I,,vie 1,i I V"Ve_` �ic cq vii it _co <br /> 1.4.4CONTRACTOR LIC.#(REQUIRED) (213 6 g CITY OF EVERETT BUSINESS LIC #(REQUIRED)) �L� �Ini id c5 <br /> PRIMARY CONTACT: ID OWNER CONTRACTOR 0 OTHER(Please Specify) € <br /> CONTACT NAME: � ;� CONTACT PHONE: Gl^ZC, .. 2 t i . ''97 7 <br /> //�� <br /> V-e i [E, P � G .J CONTACT EMAIL: ,✓°"t �v1 1.1 I V r I I LtediW)C,/ `Gjl/yi <br /> AGREEMENT'T hereby certify that I have read and examined this application and know the same to be true and correct. Al(provisions of laws and ordinancesveming 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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> (c <br /> PERMIT# <br /> / ! ;/ 1/ i E (&V 3-Ow <br /> •wner/Authorized Agen Signature Date (Revised 10/12/2015) <br />