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41ETT A...i.ECTRICAL PERMIT ARI LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> /L PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: L/06, ;, jc d <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: PI SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: RuZ_ d,ty)(, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 4 8 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES EI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: a;(IP, S �LL t�C r(�c o¢ (.2Ul/Yc-- <br /> ` ��CONNTACT INFORMATION <br /> OWNER NAME: /VI G r�C `� � �-�'IvY ,q/' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /4Z Ci U1^ e2;(_. I Gor sG Hky <br /> CONTRACTOR ADDRESS: 7/v I STREET AA3 7 1L S4. A ) ,/ry/ �T 7 / <br /> CITY �'l G lr y.(Vi'/it STATE /4/N ZIP 1(/ G'-7 () <br /> CONTRACTOR PHONE: 42 S 253- Z3 --) CONTRACTOR EMAIL: 6),-/e,i)46 sv g ro —� <br /> CONTRACTOR LIC.#(REQUIRED)://7'( L C gq 13 0 CITY OF EVERETT BUSINESS LIC.#(RE's UIRED): L4,111 'd <br /> PRIMARY CONTACT: 0 OWNER L)]CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT 7,NAME: CONTACT PHONE: 4 �' 2s3 27 S ) <br /> 0/'l/G h(L i2 ocik , 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/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 /> ac <br /> Owner/Authorized gent S gnature Date (Revised 10/12/2015) <br />