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Ot/19/?016 21 38 :78G? P. J01/OP1 <br /> �LECTRICAI. PERMIT �LICATION� � �� ��Z <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE77, WA 98201 �—�9—� 6 <br /> (P) 425-257-d810 � FAX q25-257-8857 � (E) everetteps@everettwa.gov � tiwnv.everethva gov/permits <br /> PROJECT SITE INFORMATION <br /> pROJECTADDRE55: k� �t / �ld <br /> HuiLDING AR[A (�f residentiai, new construdion,remotle;, cr addition) SF <br /> BUILDING TYPk: l7 SFR-DC-TACHEO ❑SFR-ATTACHED ❑ DUPLEX ❑ IdULTI•FAh91LY•d Or UMTS' B'�0�.1�11FRCvaL <br /> USE OF 6UILDING: C(/ /2 (? <br /> ELEGTRICAL APPLICATION INFORMATI�N • ' <br /> CONTRACT PRICE OF WORK: 5 0 <br /> NUMBER oF pEVICES (if low voltaoe): <br /> FIRE ALARM7 ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT N if a licable): <br /> UESCRIPTION OF WORK: X� � CU/ <br /> CONTACT INFORMATION <br /> OWyFR NAhtE: ( k IF T (� � , TENANT NAME(If Commcrciall: �/L J1/l�l/�u c�-,� <br /> OWNERMAILINGADDRESS: SrFecr UC' ,SnU�I�! n-/�AICNO .SUC)� /0�_ <br /> r.itv L—.✓I1 V�� STnh .',r <br /> OWNER PHONE: IOWNFR EMAIL: <br /> CONTRACTOF2 NAM[: <br /> CONTRACTORADDRESS: sra¢Fr �p0/ �U��_A-� _ (� p ___ <br /> CM Sr�: � Zio (O �O <br /> CONTRACIOR PHONE: YLS n� � Z�((�__ CONTRACTOR C-MA4: _ <br /> CaNTRACTOR uC,piReGinReol: ��'(�.Mf1'I���_ CI1Y OF FVERETT DUSIN[SS LIC.N1r+[ouiRF.u�:D/((}� <br /> PftIMARY CONTAC7: ❑ OWNEft - cONTRACTOR L]OI�MER(Pluase Spec�fy) <br /> CONTnCT NAM[: CONTACT PHONt: y�S Z3� �,2�E' <br /> ��� ��L-�-��G� CONTACT[MAIL: - --- <br /> A[,17!'ER!ENI: T hcroCy cc,a�/y nrut l hn�v msd�md ecam;m�1(h,,.�ppGcolion nntl Anow Nru�omu to bo fr�o and mrmcl. AlI p,�poluons oI/ews anJ aN;nunco:9nvCm�op�n�s <br /> typo er�.YA'x�,lr bn rcmnla�od whe7Er spec,Lnd nnm�n cr r.!. 71;u gionNnp cl a parmd dcea r.Df G�esa,r.o lo e�vo oWAorty ro v,b191e or G�ncol fnn rypLv9icn;of uny otnor sra!u o� <br /> Iccar4wio5i'��•'"�9�'���,+tt�cl.niorinnp�r�ormoncoclton;rnmlion 1r..�•lamauthu�:o76/f^PCwc�;rWfh::p'CpMytop9dOm11hawo�kfonvhrCAeppG[efl0�a13m.JCaantll <br /> cem�'i a.:h Il,d Sf.;m(:onfnvd.^r W w 7B:7 RC1YanJ 2Hfl.'00 ltnC. <br /> C:ty ol Ewie!t O&ael Usa Onry <br /> FEE <br /> � 120 � 5� <br /> PEftMiT tt <br /> � ic EI �� ' I(�2 <br /> 0 o uthorized Agent Sipnaturo nte (Ravlsed 7CL72/d075) <br />