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)4effrr ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everette s@�e erettwa.gov I www.everettwa.gov/permits <br /> o go "S4PROJECT sire <br /> INFORMATION <br /> PROJECT ADDRESS: G EiQ,y.++ VAX -��� Z - () 3 <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 4CJii f'' SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0} SFR-ATTACHED 0 DUPLE�Xn 0 MULTI-FAMILY-#OF UNITS: )(COMMERCIAL <br /> USE OF BUILDING: sgADvv,) e''1 Coo.'Jry c 6V \ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ t/ <br /> s <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` <br /> DESCRIPTION OF WORK: 5161 . i11A-C--f L� BCtkNCG'�2CLll�'s 1D <br /> CONTACT INFORMATION <br /> OWNER NAME: S Oh 0 wj IS h CU t.:,k4� TENANT NAME(If Commercial): L j iJA) (�VZC.\) <br /> OWNER MAILING ADDRESS: STREET 3 ppb oC_k�-1� eZLe a()2 <br /> CITY UC,lL t-€ / STATE ... a ZIP q'11 ( <br /> OWNER PHONE: &( L <br /> J-- ',vC'i/- 1./'f 09 OWNER EMAIL: f pG,t2_a_y ?CO SA.)ohC,11s h1 • (U Cl o us <br /> CONTRACTOR NAME: ` AO 4 t'l (C-tt <br /> CONTRACTOR ADDRESS: STREET ?)e. 1•R., (a- <br /> CITY W Or,) (' STATE t,Oct ZIP Ci V)r)'a <br /> CONTRACTOR PHONE: 47- -�VA-(‘)030 CONTRACTOR EMAIL: ®p,,; , �j j�[�t^�a_c7? ID°y CO) . CO v\ <br /> CONTRACTOR LIC.#(REQUIRED): 5( �( L(17759' CITY OF EVERETT BUSINESS LIC._ #(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: (\N,1LL,Ad\cc CONTACT PHONE: (lo ) -27- 1 rg44 <br /> CONTACT EMAIL: INItk A ft I v r eciGtoy�� Co." • <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 /> -� E ltQ r2� g <br /> lug cy 4 Q �' c/� <br /> Owner/Authorized Agent Sig . ure Date (Revised 10/12/2015) <br />