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"pr. , <br /> .ECTR CAL PER{ i Q� AF KATION <br /> -'440y CITY OF EVERETT PERMIT SERVICES <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 SITE INFO€z GlYi.r:Th ON <br /> PROJECT ADDRESS: /`-�/'r ]3 f� s 3-" <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: Ca'�R-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: /e,e_deeo <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ G <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: red 9 r✓ 4/4 j- 5 P.✓/l� <br /> CONTACT.INFORMATION_ <br /> OWNER NAME: Deb fj�p (,����! TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / 4f ,j t S t 1 ir/ <br /> Cn-' STATE L yZ ZIP <br /> OWNER PHONE: /15 72J —,Z�gy OWNER EMAIL: <br /> CONTRACTOR NAME: i) ;/- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS: seer )2)4/ Z' 5'4-- <br /> CITY <br /> ' -CITY jl•e>�� STATE L -'/-- ZIP (2.520? <br /> CONTRACTOR PHONE: y �5� S 3 4'7 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 5��L. X ?t, CITY OF EVERETT BUSINESS LIC.#(REQUIR ): <br /> PRIMARY CONTACT: E'b—WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 721—`.,�`�5 < <br /> .I7 I4'. e 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> OC) <br /> PERMIT# <br /> ✓ _ <br /> --/6"-77E .rAo - O IL <br /> Owner/Authorized ent Signature Date (Revised 10/12/2015) <br />