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OLT fLECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> /n C6�/ 2I,,/ PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: C9 f 0 W ( J PO eYe i/t/A 0 g z_03 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED `ItFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: VI V7/71g <br /> l--1LEOCTRIC ►L APPLICATION INFORMATION <br /> CONTRACT PRICE OF WOR : $ 1''O <br /> NUMBER OF DEVICES (if to voltage : J <br /> FIRE ALARM? ❑YES 4400 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �/7 <br /> DESCRIPTION OF WORK: 1i ✓ 20 (4 a1/0 rzfro( 1 it --my-lar / <br /> /,, CONTACT INFORMATION <br /> OWNER NAME: Gkp"� L17 9 7 /�K74 t7 s TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: `/STREET (P/0 (f' C-'JJ'�o� oly i (i/ <br /> CITY �V eI V 1 l STATE C�r / �/ /ZIPC/g 2(/ <br /> OWNER PHONE: (20t0)1_00--S <br /> S?Z1p OWNER EMAIL: ,c7akUt is lV" a�J ' • C / / <br /> CONTRACTOR NAME: 11/7 /VI le F ll eC trio <br /> CONTRACTOR ADDRESS: STREET /0/ EJ(/ // I� 81 Lc <br /> lJ I <br /> CITY /vy X Y �j STATE /Am ZI e 2 e <br /> CONTRACTOR PHONE:(42S)2 -,42/,CONTRACTOR EMAIL: 0/CM,ccc)in ktuc@I ec-I- • --- <br /> -.=-",- <br /> CONTRACTOR LIC.#(REQUIRED): // ot4ES'526 CITY OF EVERETT BUSINESS LIC.#(RE IRED):Q`1`1/LU% �.1 <br /> PRIMARY CONTACT: 0 OWNER " NTRACTOR 0 OTHER(Please Specify) <br /> -CONTACT NAME: Ke sez CONTACT PHONE: (/420) D -L CONTACT EMAIL: 1M ep r [is co)) KV) //. C6ryi <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of aws and ordinances governing this type <br /> 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/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. w/ /�/sn, n�e f -fj c <br /> J/ / Vl,i � <br /> 1 I I.CSV / r / <br /> City of Everett Official Use Only <br /> PERMIT# <br /> A 44 l lS / 7 E nc - ` 7 <br /> Owner/Au orize.Y'gent Sig ature / Date (Revised 9/23/2016) <br />