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ECTRICAL PERMIT A mr LICATION <br /> /11j-i'411W CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 ( FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 22 0;2- /`l ` '00 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX El MULTI-FAMILY-#OF UNITS: L7 COMMERCIAL <br /> USE OF BUILDING: p 7L‘, e rf vte A a" - .e • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ S'00 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 12140 <br /> ASSOCIATED BUILDING PERMIT# (if applicable): ig 16 a(" -p 5' 6 <br /> DESCRIPTION OF WORK: /2.r".7 / // c../4 vti/e`, f r <br /> / /3'y✓� -ac-��� /' j 7 cc` s? /z /�' ) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE t ✓-f ZIP <br /> OWNER PHONE 441j--- 71-'7 O 7O (: OWNER EMAIL: / Caw i c-, ,. (...A•-•--/-45, <br /> CONTRACTOR NAME: /3. c k 'e c / /ec k'.-c ,L L C_ <br /> CONTRACTOR ADDRESS: STREET p0 13,„,„‹ p-G <br /> CITY /3vlJi.'y�r"�, STATE 4111 ZIP J Z,�V <br /> CONTRACTOR PHONE: 3C C '7,J` 7 —G J IJ CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): CSS-44,2 6 <br /> PRIMARY CONTACT: ❑ OWNER Et'CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: to j- j7 j ?'02 <br /> C'A✓c/cc hcnfP. CONTACT EMAIL: C` /,/ /" /f e z, C_v, /e- <br /> �7✓t' L � �? <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 /> 11,1 <br /> , 69i <br /> PERMIT# <br /> 4/,/e4 8 � Z� �I(0 E ) JO \ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />