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04/26/2016 19 : 45 #0331 P. 001/001 ICTRICAL PERMIT AF ,ICATION OLT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (F) 425-257-8810 j FAX 425-257-8857 1 (E) everettepsi everettwagov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ld �i -�`' Crf1 I T cp v- LS II BUILDING AREA(if residential,_ new construction, remodel, or addition) Sr BUILDING TYPE: Cl SFR-DETACHED Q SFR-ATTACHED 0 DUPLEX .2-MULTI-FAMILY #OF UNITS: tors 0 COMMFRCIAL USE OF BUILDING: AhrAitf tat ELECTRICAL: APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ f 600 NUMBER OF DEVICES (if low voltag_e): FIRE ALARM? D YES Q NO ASSOCIATED BUILDING PERMIT##(if applicable): DESCRIPTION OF WORK: D/41/KA-6-0) 141 1 ) -to°o[r 141 LlJl - F& ula-i r C4 Rri r t., fr r15 !J- FIE6- 'c rA AA/r CONTACT INFORMATION .• . OWNER NAME: Cj'e44,p/ed, 4\--cce_oftA, TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2{Ls Ilk p- � �r^ CITY .j f STATE ZIP .%)-SO OWNER PHONE: .� � I? 2 OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 262 O f 21( c f I4-U• . r crrr J , STATE zIF !/ e CONTRACTOR PHONE: )- ' �[�! . CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): (j , 1fJ/V,, • CITY OF EVERETT BUSINESS LIC.#(REQUIRED) C 4 . ? PRIMARY CONTACT: 0 OWNER Q CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Y2 ,.( 27` 2 X, 3) •4- 4x4,,7 CONTACT EMAIL: AGREEMENT.T hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 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 comply with the State Contractors l-aw 18.27 ROW and 298.200 WAC. City of Everett Official Use Only FEE PERMIT it / E coo j Wnor/Authorized Agent Signature D- - (Revised 10/12/2015)