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77 <br /> 01‘1".---A <br /> ELECTRICAL PERMIT APPLICATION t4. <br /> ,.. , ,,_ CITY OF EVERETT PERMIT SERVICES N <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 /> PROJECT SIyTE_ INFORMATION <br /> PROJECT ADDRESS:1A a Ves e r '7T <br /> BUILDING AREA(if residential,new construction,remodel,or addition)C {- AA, SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: hOt e <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ is <br /> NUMBER OF DEVICES (if low voltage): („Q <br /> FIRE ALARM? 0 YES SNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: *W-I V I no) s'efur 3 49, c, - ,, '\ <br /> )_ ( CONTACT INFORMATION <br /> OWNER NAME: 'To r ne"T e � I..X T c-'O (ck. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 T 27 V e-) V" V) <br /> (gyp�( <br /> coy .6)-etre,-0- 1 y `` STATE Wfi.•^" ' ZIP I .� <br /> OWNER PHONE:` "'fCfli5 "1 .� ) OWNER EMAIL.:1-0!"1 e,'i'5 .�..0 Y (ii,i t .e t rn <br /> 0 <br /> CONTRACTOR NAME: I )()3 <br /> ,Q, <br /> Sec ,,i�I l''4-.1-1. (k I,, 0`„)A(X <br /> CONTRACTOR ADDRESS: STREET <br /> CITY )(1 O► O\ g '\ STATE a ZIP /f_�ryrn(} 9 $CONTRACTOR PHONE:3(PV`(291 ' 3'0 CONTRACTOR EMAIL: qt)^y(', , WS-Calif(- ti 4Ot -bi-i <br /> CONTRACTOR LIC.#(REQUIRED):Neia CeSSCi l 9 pc, CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 15 <br /> PRIMARY CONTACT: 0 OWNER '`3'CONTRACTOR 0 OTHER(Please Specify) ___ <br /> CONTACT NAME: CONTACT PHONE: O i t D <br /> L z',A , CONTACT exC. . ,t tiPt <br /> Ili tti9t` ,lid 0 t . <br /> AGREEMENT:T hereby certify that t have read and examined this application and know the same to be true and correct. All provisions of II ws 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 /> c\f i ui�, ) 4 i ig E B cAs - cS <br /> Owner uthori Agen &f nature at <br /> g g D (Revised 10/12/2015) <br />