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Jan 0516 02:58p �� 1 (�Q OWE l+ I c/�od/`-TJ a fo p.1 <br /> • PROJECT SITE INFORMATIOIe I..(,..16 <br /> PROJECT ADDRESS: tp 0 b Cl1J-eikL t d ' 1 f <br /> BUILDING AREA(11 residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: FSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION • <br /> CONTRACT PRICE OF WORK: $ . 200 a% <br /> • <br /> NUMBER OF DEVICES (if low voltage): I <br /> FIRE ALARM? 0 YES [ O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: r-e--f-►� -1--- -1-0-4-s a•r d r-cGonn c---/- I is ,e <br /> • <br /> 'L j,�//�j�,',��. 1 �, CONTACT INFORMATION <br /> OWNER NAME: •l rl 5 r 4 ) Le- . TENANT NAME(If Commercial):� <br /> OWNER MAILING ADDRESS: SIR= <br /> c--. <br /> OWNER b c� (�V --1 �� d Five-_, <br /> " <br /> cnY e, ) 04 - L STATE t,Ua zp'9 I <br /> OWNER PHONE: + - 7 101 - 461 5 Z.. 'OWNER EMAIL <br /> CONTRACTOR NAME: (A() ►r(.t 3 1`Y) +1-ct 4.- �,,,. v I-6,t <br /> CONTRACTOR ADDRESS: sTHEEr 4 I ` / t U Cn L <br /> CITY rnq Com-\/I I STATE,�,,"�) /' Z' / 4Z J7 <br /> PHONE: 3 5. '� 'CONTRACTOR EMAIL: (�G# ZJ) i h ei(ci�me a.6-1-. <br /> CONTRACTOR `T,�"��.. <br /> CONTRACTOR LIC.#(REQUIRED):` 06116t. 1-75 V-1/1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED` . 1 <br /> PRIMARY CONTACT: 0 OWNER ITCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: L&-. j_ --- 5_- 2-1 0C j <br /> -170/3.-101,e____ CONTACT EMAIL: <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 laws and ordinances governing this <br /> type of work wet be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cane/the provisions of any other state or <br /> focal law regulating construction or the performance of construction. That l am authorized by the owner of this properly to perform the work for which application is made and! <br /> comply with the Slate Contractors Law 18.27 RCW and 296.200 WAG. <br /> City of Everett Official Use Only <br /> FEE <br /> 1vo <br /> . PERMIT# <br /> i � =�1 , Ei �00I- 62(� <br /> Date (Revised 10/12/2015) <br /> Owner/AuthorizedAg 011 ,,,,„ _.... <br /> Signature <br />