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4Efr-77- E ECTRICAL PERMIT AP .ICATION <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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: I3v tiv �S S,L.4 -u <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED Ei SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: f kcc�K <br /> A1 JJ <br /> CONTACTI�NFORMATION <br /> OWNER NAME: F:646424 ► l IUYI� Mo ` e 14 � T NANT NAME (If Commercial):e <br /> OWNER MAILING ADDRESS: STREET 142-2 S ��L� J L� . IOOc <br /> CITY lkit STATE 1 ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1 li�1 f" - WYL 1 ( YUy�- LSOLiAJA Uvk S <br /> CONTRACTOR ADDRESS: STREET ?P `14&»4 11$ <br /> CITY Kitlj\IL.LL ^STATE G� ZIP 1 &2,9•0CONTRACTOR PHONE: :2)t,00 • LOSK • 1 S6C CONTRACTOR EMAIL: 1►"S�`�C.J Q I� � 6_C3y1Th <br /> CONTRACTOR LIC.#(REQUIRED): I Ae-- C1+AL; K-14 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER Pi3CONTRACTOR El OTHER(Please Specify) <br /> CONTACTINAME: CONTACT PHONE: Ng) ,,��`n 1 SOO <br /> -�_ Il.it ai_f CONTACT EMAIL: I cJ t lL un 1K m . C_OVV\ <br /> AGREEMENT:T hereby certify that/have read and examined this application and know the same to be true and correct. All prov cions of laws and ordina4es 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 <br /> FEE <br /> PERMIT# <br /> [12/1 E I&CIS— <br /> Owner/Author zed Agent Signature Date (Revised 10/12/2015) <br /> .1 <br />