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ELECTRICAL PE ' IT '''LICATION <br /> . - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Li /\5 3')' /3V1C 4,4 ) <br /> BUILDING AREA(if residential,new construction, remodel, or addition) SF • <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ &C'Q00-o prA,A../IF-I <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 0041`v /) C)O A_ ©Pr- ti ( e <br /> CONTACT INFORMATION <br /> OWNER NAME: JAA,//f/ U 4 ,.( (cm, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET y725' ,L33`�'( 4(/( <br /> CITY P/ f t STATE ( J� ZIPr,.20. 7 <br /> OWNER PHONE: y),S 3 y.: ,5 is 2 L OWNER EMAIL: <br /> CONTRACTOR NAME: fcl./`-14 ,f7,41_17 / f E/'4 /el— <br /> t14_71R <br /> CONTRACTOR ADDRESS: STREET 3(0c I 1/ ` R7 . i <br /> CITY E VII L 7 STATE i ZIP ((� / <br /> CONTRACTOR PHONE: V2-.I 7 -2 f t / CONTRACTOR EMAIL: LLL <br /> CONTRACTOR LIC.#(REQUIRED)- /(,asy1u 9- ,CITY OF EVERETT BUSINESS LIC.#(REQUIRED)G/(off 3. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: j / CONTACT PHONE: l 7j ) 7 / 2 .2 <br /> tf t, I,� 0` A CONTACT EMAIL: c <br /> AGREEMENT.'T hereby certify that/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 /> °,,P <br /> PERMIT# <br /> 7tzedtSianature Date (Revised 90/92/2095) <br />