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1,—i <br /> ELECTRICAL PERMIT APPLICATION <br /> 011gVCITY 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Z 4-Z- Z L.01 by Av L L Je.re_k- t W A C([�v LCA <br /> BUILDING AREA(if residential, new construction,remodel,or addition)Z-b.l VA �"``,,.eZZ4k w6F <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: L_op-tf,ev (. <br /> ...l C,) <br /> Dr" Uvt+ V\Oi ( 0 ' A -1-rVl <br /> i <br /> 7 p e.Ye&c - sSO�-Ifc O <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ P/500 <br /> NUMBER OF DEVICES(if low voltage):1 <br /> FIRE ALARM? ❑YES IiNJO <br /> ASSOCIATED BUILDING PERMIT#(if ab '11 able): (� <br /> DESCRIPTION OF WORK: Tv►ytrw�1iv\(5 CCCCeS5 CsDralo\ y5-e rvN ko A-e w CJ�'f<(..t <br /> Aoor5 3ZO Lr"toiv► SuCvc exn lrtc.e.) && 2,C,k :h A4/\C J‘95 tv5 <br /> Q)('AvV, On & c). o VLSrroOr". CX430 rg. <br /> (�f CONTACT INFORMATION <br /> OWNER NAME:5noll9m(. 1r1 C-CVAAy Vectruie✓5 NhcajoAENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z4-ZZ CoVO y ,PW-e_i 1,DA Z,U U <br /> C ITYr, � v�- l STATE ZIP Cl 01,o i <br /> OWNER PHONE: (.4 Z'5)'3C('-b '5 56 OWNER EMAIL: <br /> CONTRACTOR NAME: \ c 51l to kali'M <br /> CONTRACTOR ADDRESS: STREET 2.-6--50 A.,,,c,'Jrf k...:, z, <br /> CITY ),,e1-4-‘42_ STATE w A ZIPC10 t 3(4 <br /> CONTRACTOR PHONE: ' CONTRACTOR EMAIL: QE't/v'1l�5 4Stiiv`6 VOK Ak4v� .(.olv. <br /> ,*f <br /> CONTRACTuR Lit.:.#(REQUIRED): tk�5KY AVZ a( 27 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0 1�j' )PRIMARY CONTACT: 1=1 OWNER L5!'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( to G) a -- E7 �5O 1 <br /> i'"'\(atiivk.), artke e.rj CONTACT EMAIL: Ve,rri 1'-, J t/ja5vtiv,j6ht-'`6,,,9,'C-`J r. <br /> AGREEMENT:T hereby certify that 1 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 /> -..mi., - <br /> / /, .-', ------ Ci /15/1 6 EC , L2_,09 ____ 02_( <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />