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*77 ELECTRICAL 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 I www.everettwa.gov/permits <br /> PROJECTttSITE INFORMATION <br /> PROJECT ADDRESS: O O ( aV 1 v'2 tz ( 7 Au L <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ElSFR-DETACHED ❑SFR-ATTACHED I=1DUPLEX 0 MULTI-FAMILY-#OF UNITS: EL MMERCIAL <br /> USE OF BUILDING: 5 I�� ✓v <br /> LECTRICAL PPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ I G 007 <br /> NUMBER OF DEVICES (if low voltae): <br /> FIRE ALARM? ❑YES MO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 11 <br /> DESCRIPTION OF WORK: (9,1,=1;W 1 V. I_ ( F_ )U- 1 }2 ) T ,/-) s' <br /> CONTACT INFORMATION <br /> OWNER NAME: (/(1( C Uv A c 0 C0 . TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.O0 ( J( F ? ( �/ -' -0I <br /> V ,P 1 CrrY (A) A - STATE O/ 6 2 o ( ZIP <br /> OWNER PHONE: � 2 lj 2 G 1 - ( - , 1 OWNER EMAIL: <br /> ` -1---F. 7 � ( C ( / IN C <br /> CONTRACTOR NAME: �J ( �/�/ Y� � C��i��C-- <br /> CONTRACTORADDRESS: STREET I �j K' C' cj t"."-c Tc, Qbt JD <br /> Go.,J CITY i s) /r STATE /6 2:1 t' ZIP <br /> CONTRACTOR PHONE: 6c - 7 7- 1 3 O CONTRACTOR EMAIL: 111 <br /> CONTRACTOR LIC.#(REQUIRED): R-)( ( / I ( t 2{7 CITY OF EVERETT BUSINESS LIC.#(REQUIRE •• O 2( 9,q <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT/ NAME: CONTACT PHONE: .6, O__ 7s 7- I;(y <br /> 1 9-1 ✓\ V( Uv` ( CONTACT EMAIL: <br /> AGREEMENT. T hereby certify that I have read and examined this application and know the same to be true and correct. Alf 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 /> . `M - S 0 <br /> PERMIT# <br /> ;/� / — / 9— 2o/ E li -o - l29 <br /> Owner/Authorized Ag Signature Date (Revised 10/12/2015) <br /> 1 <br />