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LECCTRiCAL PERMIT 1PLICCATION <br /> ._art TT <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] www.everettwa.govlpermits <br /> PROJECT ADDRESS: /Q 0 / 9 rY2O4 (- j4G <br /> BUILDING AREA(if residential, new construction,remodel, or addition) 13 i 00 0 SF <br /> BUILDING TYPE: ❑ SFR-DETACHED/_ 0 SFR ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: LI COMMERCIAL <br /> USE OF BUILDING: S Le -P0.041.1, t - ',den L ovi <br /> :.. .gP4P 1R1P:Ak A1t:T>L <br /> q.WM SII <1 9gIVIATtcnk ' ` <br /> CONTRACT PRICE OF WORK:$ (.0 500, • O‘. • <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES to NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): -/� <br /> DESCRIPTION OF WORK: /2n <ii Lt?L1/ctom? l c)t-L ,/ c344(� oitoef ict4ces <br /> yUo s. .F /Lc -C <br /> ..� ..: : : ...... : `..::-::..:: CONTACT-INFORMATION: : .:_: • . ._.. . .. _: .. . . .... .... <br /> OWNER NAME; Q -G..til A/c/6, .e.,/,4 TENANT <br /> TENANNT NAME(If Corn ercial): /_ <br /> OWNER MAILING ADDRESS: STREET /D/d`7/` 1 "�Q4,/ 'f Ci ( -1794/a-54 ?2,0 <br /> CITY STATE ZIP <br /> OWNER PHONE: Z S 5) q / ---(930/ OWNER EMAIL: <br /> w,w. <br /> CONTRACTOR NAME: Ejc J/1/41 Com/ C _-�'C <br /> CONTRACTOR ADDRESS: STREET /` �LL,�,0 c �pfrit sJ s Q, �( x�y <br /> CITY <br /> p 1---4 4 (Sk.v i "-S STATE Com.f� ZIP G C?2_S U 1 <br /> CONTRACTOR PHONE_ 2a(, - p 53"(9 y2 CONTRACTOR EMAIL: ( ba.G41- /(4)a S yt--� <br /> CONTRACTOR LIC.#(REQUIRED): �7T `AI CITY OF EVERETT BUSINESS LIC.#(REQUIRED): aS3 6 9 <br /> PRIMARY CONTACT:Y OWNER El CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZO (o--% 5 3 <br /> k e <br /> C 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 ofEveretf Official Use Only <br /> FEE <br /> fj+' <br /> ! <br /> Adg"iiiii&F"li AID 5. 2 y/6 <br /> PERMIT# <br /> F <br /> Ouvner/Auffiorized Agent Signature _� Date (Revised 90/12/2095) <br />