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! .....___, <br /> LECT KCAL PE r MST i': ILICAT O N <br /> tliW- i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 J (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> • <br /> Q / 1 PROJECT SITE INFORMATION <br /> ADDRESS: ).,0 ` ll l �'\`QJ\--N) - ' <br /> BUILDING AREA(if residential, new construction, remodel, or addition) \t" -c) i-kF'•t ivity1ii) <br /> BUILDING TYPE: 0 SFR-DETACHED El SFR-ATTACHED ❑ DUPLEX El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: \t�LJ . <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ j\c' , '" <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? El YES liNO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): ` <br /> DESCRIPTION OF WORK: (2-exv(a`Q.- ` '1-\0,_\--c- \r-..O3t) <br /> `V..\ Zoe V.,ANR P . <br /> . <br /> CONTACT INFORMATION <br /> OWNER NAME: It ili, UO c\ LQ l)\j.Sr-t( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET` (1\7-15 \ \,� % <br /> Af 1 \Nk_ CITY \)v� i STATE ZIP 5/61 <br /> l <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: iivs ' jr) F/r (/1/ [✓ <br /> CONTRACTOR ADDRESS: STREET /35 7 7,„, it-z_ j7r ._> <br /> _____.. <br /> CITY ,<M/l O/n4 STATE v'J/'�%/ �,(//�— ZIP W7 I <br /> CONTRACTOR PHONE: 4 L S 26,6 S-S i/ CONTRACTOR EMAIL: A1/.3/41-) i, , Cbe f%c_e_,j pf f, / L ply.) <br /> CONTRACTOR LIC.#(REQUIRED) A Us Al t $.i0 CITY OF EVERETT BUSINESS LIC #(REQUIRED): 6,.,V 3 0 p <br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 'i OTHER(Please Specify)l\M S`(\uKV\i\ <br /> CONTACT NAME: CONTACT PHONE: `l!; 4Lc 3` -- 2)Aci <br /> /S\`I\ CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances 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 /> 01, <br /> PERMIT# <br /> .k (\\( \ \ <br /> ,(\ A 0k <br /> Owner/Au orized Agen Sig ature Date (Revised 10/1212015) <br />