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_ECTRICAL PERMIT ALIGATION <br /> '`4dWCITY OF EVERETT PERMITS VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-25T8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> 'r <br /> PROJECT ADDRESS: 9 fO L.( S ? f;V at i 1/0A. q2°3 <br /> BUILDING AREA(if residential, new construction&model,'or addition) 2 bg SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: C7k(W)F7 • <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: <br /> CONTACT INFORMATION <br /> . <br /> OWNER NAME: Ay1CLCP-- l_.-, Je TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET5 cD H 5 • , •, CIS <br /> (2,03 <br /> CITY 6\,e/"b ) STATE A)f?f-��,� ZIP I� <br /> OWNER PHONE: (414-) �j�l -tk-aCk / OWNER EMAIL: S hip. f- UYvU elf. co,(N, <br /> CONTRACTOR NAME: .c— <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: QWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ' 5") — <br /> / Lc i.,‘) CONTACT EMAIL: Arcs <br /> sk <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 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 m <br /> FEE61) <br /> 1 )k)1/4jL (321fbCfl -4;k l/�y'"��/!//JJ ►►�^1-,(�{[,✓}I/ <br /> DU ' <br /> 41g'-i <br /> PERMIT# <br /> DA104-64,3 c5/N-eAA-1,' 2- 9-iplt, At - E k512,-0g)* <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />