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--EGTRICAL PERMIT AFCCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)4.25-257-8810 FAX 425-257-8857 J (E) everetteps@everettwa.gov[ www.everettwa.gov/permits <br /> PROJECT SITE INFORMATIONN <br /> PROJECT ADDRESS. �� C.,(../1 C� <br /> BUILDING AREA(if residential,new construction,remodel,or addition)_ SF I <br /> BUILDING TYPE: Z4 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: T1O(Yl� �� 120 X71 (TC <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ OCA <br /> NUMBER OF DEVICES (if low voltage): N I <br /> FIRE ALARM? ❑YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ' A' V-I?Ai -(�`a <br /> CONTACT INFORMATION <br /> OWNER NAME: t" (A!.0 1p' I--D alb LTA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET J-AM2t <br /> cnY STATE ZIP <br /> OWNER PHONE: OWNER ENTAIL: <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: STREET 110 3� v L 1 h <br /> CITY STATE l.'V 'r� ZIP <br /> CONTRACTOR PHONE-2-0& l"1 q- LAS 1 S CONTRACTOR EMAIL: t rrZ , I-o C 0+�S Ctih vo,C t Yl <br /> CONTRACTOR LIC.#(REQUIRED): ��O I- ES C.:1 r,LA-Z- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER _it[CONTRACTORS ❑OTHER(Please Specify) '- <br /> CONTACT NAME: CONTACT PHONE: 2a U <br /> 1-�C)vv S CONTACT EMAIL: M,V10 w 2S C ��'1S '�L i( l��: C CS t/1/, <br /> A(3REEM TNT:Thereby certify that I have read and examined this application and know the same to be true and correct. All provisions offaws and ordinances governing this <br /> type of wodc will be completed whetherspecl6ed herein ornot. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local taw 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 /> DO <br /> PERMIT# <br /> N� 01 <br /> (Revised 9011?12015} <br /> OwnertA orized .Qent Signature Date <br />