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LLECTRICAL PERMIT APPLICATION <br /> /IIIII.4 "---A <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: :13 I(1^ , 9 -k SC✓ <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ C'I') <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Vh4 GL- St4-'7'f f- rj-- /aEC &-7,1 <br /> ''' CONTACT INFORMATION <br /> OWNER NAME: 7,:t t LV1 it f C!c /A/zrj TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET gt 'Y - 5 7 SC <br /> 4 CITY 1-,----t/e --j----1-,----t/e1-,----t/e --j---- STATE (,/l/ ZIP qy <br /> P� . 19 OWNER PHONE: -tc;-t- - ;3,?' 0 'OWNER EMAIL: <br /> CONTRACTOR NAME: L/tib- ( f C FK---CC__—_ <br /> ADDRESS: STREET 7(Y7 4{ (820 /)J-c,.( 4/6-- <br /> CITY G>«0 i (/ STATE (A/ — ZIP 7S0�C7 <br /> CONTRACTOR PHONE: '‘57V-r-2.73) l CONTRACTORyEMAIL: (AA((C/ 1((406--A-L-(-1-1 (J cz- , Cc9l� <br /> L(Q <br /> CONTRACTOR LIC.#(REQUIRED): (.,(, f:2-- - C.0-1--U CITY OF EVERETT BUSINESS LIC.#(REQUIRED): D lerl o <br /> 61 <br /> PRIMARY CONTACT: 0 OWNER ''CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /� CONTACT PHONE: i(c3-1=O cs )- 7d'9 <br /> CCE L(1.0( CONTACT EMAIL: ttit t (-a- . l f n A(i.2(e di., lc_-C <br /> AGREEMENT:1 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 type <br /> 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 /> / J PERMIT# <br /> 1119 - �/ ��t 7 ELL - 0 <br /> Owner/Authorized Agent '.nature Date (Revised 9/23/2016) <br />