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LECTRICAL PERMIT LICATI®N <br /> OL 16 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: '08 Z COL, C-Vc tZ---77` <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: 5/�(T��� F✓9N41 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ( C°ZTt v ikJ c,,f-4rc7y U K/ 00 w - T—i., CtU C)AJ <br /> CONTACT INFORMATION <br /> OWNER NAME: 5 T— - jk4l C--5 TFe��(If Commercial): �/UI( j/�C'�✓�� <br /> OWNER MAILING ADDRESS: STREET J+ �l 6 <br /> CITY laeIUL) US-� �/ STATE /r/( 7JP O.I <br /> OWNER PHONE: 14'? 5^ `� O 7 OWNER EMAIL: rC(e� �c��S ` (L i/Lr G7/� C.crl�vl <br /> CONTRACTOR NAME: ✓v! ( Vk C4 <br /> CONTRACTOR ADDRESS: STREET f✓1 t��t� /f`1�dl, <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 10 1 - ' <br /> CONTRACTOR LIC.#(REQUIRED): 414101 tCH L 6 7 I tt/"� CITY OF EVERETT BUSINESS LIC.# EQUIRED): (, <br /> PRIMARY CONTACT: M OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: A � CONTACT PHONE: Z i �''�� 0-71 -7 <br /> >L � (/V` CONTACT EMAIL: 1/441 C✓CC �}Lvi @S <br /> AGREEMENT.,Thereby certify that I have read and examined this application and know the same to be true and correct. All provisions 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/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4 <br /> — oa <br /> PERMIT# <br /> OwnerlAutiiorized Agent Signature Date (Revised 10/1212015) <br />