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•ECTRICAL PERMIT AI LICATION <br /> 'ISM <br /> /1111P1-1_ CITY OF EVERETT PERMIT SERVICES I I e1 - /6 <br /> 3200 CEDAR STREET, EVERETT,WA 98201 G1601 -101 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: I('/i CP(.t'Q Y' --/--r-e ft- F vet/Leff Iv4 <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE:kSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: tit,m <br /> `- ELECTRICAL APPLICATION INFORMATION <br /> j <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1LO tette_ 2X col) q.Ke 1.0k EL a00aGvina <br /> tkf ka 5 A.c�t-e C' _ ���i.( s 1( <br /> t <br /> CONTACT INFORMATION <br /> OWNER NAME: -milk p i'��-�I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET [, / _ dD f 't <br /> l C' a � <br /> �/ `CITY /LI IACr �ry� n STATE Lk)/"I ZIP ged0I <br /> OWNER PHONE_ . —! 5-- 3`1 _sz„ati._ OWNER EMAIL: �t i�l4J,DQ,��nT r..30 5ffleii I I ,l 0ww,: .._ .,_.. <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> A <br /> PRIMARYCONTACT: �WNER�..❑CONTRACTOR X❑OTHER(Please'Specify)` _..�.���_�...__.........w�rw.m�.:....... .x_..�_....�...,_�..,_.______..e.__..._. <br /> CONTACT NAIllk t CONTACT PHONE: LI?c-----3q t S l , <br /> Toni ��� <br /> � I CONTACT EMAIL: ler 01-Ef7TJ Mai'f,U901 <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 ap�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 <br /> .. n0iif)fs <br /> // f <br /> PERMIT# <br /> oftdg. E,- �l� Ike ( \DI <br /> Owner/Au • 'zed •• *Signature' Date (Revised 10/12/2015) <br />