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`LECTRICAL PERMIT AP! -ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: L Lu J & we L\j e cct V A l <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑llSFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: d-COMMERCIAL <br /> USE OF BUILDING: VVIR ee(1 J�O( <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ C00 <br /> NUMBER OF DEVICES (if low voltage): LA filvlmina d s, j <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 'Z L51D 6\owNClel le`p'er iot <br /> n-Iv c h viall SOVIS <br /> S <br /> CONTACT INFORMATION <br /> OWNER NAME: L �(� �rUCtC�W(1 l'��ii(�Lit-TENANT NAME(If Commercial): i`C(a✓' <br /> OWNER MAILING ADDRESS: STREET + "( . rl Co ' t L3WC x de a,r+Men f 'P 0"&px 1i,l c <br /> CITY 0(_'et STATE �L.. ZIP (0= <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTORNAME: Ade ss n nn <br /> CONTRACTOR ADDRESS: STREET Z t4A C(Q S. Q�] 7 2 <br /> 2 CITY J ' .01-)V1 STATE WA zip S ( 1 3 <br /> CONTRACTOR PHONE: i, ) 'ILA- 1SZ CONTRACTOR EMAIL: `>Te �nIC IAC P�S1 YI.CDS /gyp <br /> CONTRACTOR LIC.#(REQUIRED): t'IC.`i('2\S C 17 CCITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER qCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:"JW) 11VA- 13Z 5 <br /> ( <br /> L 1✓\IA 7L,l s� CONTACT EMAIL: �"Ae�oniee <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 1 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 /> L . <br /> PERMIT# <br /> IVY///IZZ ./ � E -- IL <br /> tl O erlAu onzed Agent -nature Date (Revised 10/1212015) <br />