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*7w ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> c, PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: R 6D I 1 6L� Ci'`s f-1. v c�fc 'I (ic%CI �'Zo <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: Q,COMMERCIAL <br /> USE OF BUILDING: CG--N r vc-1/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): 2-- 7 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: i,i,'rv9 I,:�j Cc::N,'.,,,/ 4i et�c��C' � <br /> i`4 v s u4 C 4\`'S f r' /. <br /> CONTACT INFORMATION <br /> U <br /> OWNER NAME: Oa(./ 44,-)c,-;(1/2, L <br /> t2.1 �) �G(C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (2- T <br /> 0./ 6 'X (5 7 <br /> / CITY I cK'�Gr f I STATE 0r ZIPZI9 7(/ /5 <br /> OWNER PHONE: SG3 '6 SSA 2'J / OWNER EMAIL: CC4 J y/ .0 'Act",S c c(S(%77 Ni! _ CG-I'17 <br /> CONTRACTOR NAME: Dei v,`c 4r U r'dk7 r',/ �7 (R5« A' `, l CD( <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(R:QUIRED):Q VP <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR VJ- HER(Please Specify) WI C4-'0? to� <br /> CO TACT NAME: CONTACT PHONE: Set 9— >70 -OS L/ C�e// <br /> !� / <br /> 1 !1/I d (1� `/ CONTACT EMAIL: �'os; ✓Y/G;•7 �1 Q 'y/GG'U(J- �G� <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 Paws 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Air City#of Everett Official Use Only <br /> r <br /> 3 6i/Cs E vt0 — 00(0 <br /> PERMIT <br /> • ner/Auth.rized Agent Signature late (Revised 9/23/2016) <br />