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E _CTRICAL PERMIT AP I ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9 201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I 1W. <br /> everettwa.gov/permits <br /> z PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: q o>!t!1a Ferq/ A V F (%V� <br /> 5 Gf /L/�� . C( g�. 1 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) 4e MOOT e SF <br /> BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF NITS: ❑ COMMERCIAL <br /> USE OF BUILDING: Joh FICr✓ti /' , ofje& <br /> �tiL'ECTRIICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ,-( D <br /> NUMBER OF DEVICES (if low vpltage): <br /> FIRE ALARM? ❑ YES i NO <br /> ASSOCIATED BUILDING PERM # (if applicable): /V/11 <br /> DESCRIPTION OF WORK: lq C.C_ 164,10 d <br /> I-l1-v o ;-oY- k, S to fl t <br /> / CONTACT INFORMATION <br /> OWNER NAME: 3+_"Vt° Eat!WU TENANT NAME(If Commercial) <br /> OWNER MAILING ADDRESS: STRFFT 3�(p f jf i5 (e.(-a A_V F_ <br /> / CIrY GVt `C 'L/ <br /> ✓ STATE ZIP C) C <br /> OWNER PHONE: �S3-63-�, --vo S OWNER EMAIL: ��e mot , coko <br /> CONTRACTOR NAME: P-60 E LeG f-►�, <br /> CONTRACTOR ADDRESS: sr,eEFr (e S IJ�CGI l 1 <br /> CITY STATE LAX ZIP 3 <br /> CONTRACTOR PHONE: �O(P��3�--083 11CONTRACTOR EMAIL: k_r t �(E'G+✓'t C IA/GL Gl9 c{ <br /> CONTRACTOR LIC.#(REQUIRED):�Lo�t° ���JN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 9'5- t�t <br /> .i9 <br /> PRIMARY CONTACT: FOWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: // CONTACTPHONE: 2-65—(o -) —�Q <br /> ¢'eth? 6,/(,j✓Gts CONTACT EMAIL: S le ? P"A, co Pt 'q <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All p ovisions of laws and ordinances 7oveming 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 vioM to or cancel the provisions of an other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to porlDrm 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 se Only <br /> PERMIT# <br /> er Authorized Agent Signature Date (Revised 9/23/2016) <br />