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04Err LIECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITF INFORMATION <br /> PROJECT ADDRESS: 1 I A TAW/Cie- A.\/ /iT <br /> BUILDING AREA(if residential, new construction, remodel, or addition) _SF <br /> BUILDING TYPE: El SFR-DETACHED ❑ \SFR-ATTACHED 0DUPLEX MULTI-FAMILY-#OF UNITS: Jl 0 COMMERCIAL <br /> USE OF BUILDING: L3 r L I VI U\36- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES )NO <br /> ASSOCIATED BUILDING PER IT#(if applicable): <br /> DESCRIPTION OF WORK: t-1) S-C-OP- T (DATk06-- `1I1✓1��L- <br /> CONTACT INFORMATION <br /> 1� <br /> OWNER NAME: VQ--1------n- <br /> -I-f[ (-4çj($j�(r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3jC)S7 CO-64 til <br /> CITY E_Vr 1_2 o C l STATE i jA ZIP 1 QC( <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: - UA ti) r,0 S1--- ____u(2._.) <br /> r� r <br /> CONTRACTOR ADDRESS: STREET 5-O I /K r_� B Cx_-K 1 S) (q KI-12.429' <br /> ,[/ /% <br /> CITY i:: /VV L4- �,;4( j� STATE IAV IL- ZIP O ��/ <br /> CONTRACTOR PHONE 6( 61- ©[I CONTRACTOR EMAIL: A.14 FD{h/iice__'W(iuAaDl'-C-12 (r-( CAh <br /> CONTRACTOR LIC #(REQUIRED) 4 2 )Sr��3, -K----- <br /> ` CITY OF EVERETT BUSINESS LIC.#(REQUIRED) O J3(4 L 3 <br /> •PRIMARY CONTACT: 0 OWNER � \ TRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME , <br /> CONTACT PHONE: _6( L/L// 5-5 / <br /> 3 /c <br /> • TLJ"/ -lJ� 7QONTACT EMAIL:AiltA. DA/J4463 4- `0140 <br /> ft <br /> �L.12 f()/ <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 of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 6 oic (4/� E `e\L 2_ -002 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />