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El ECTRICAL PERMIT AN IIS LICATION <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) everefteps@everettwa.gov I www.everettwa.gov/perniits <br /> PROJECT SITE INFORMATION <br /> /4 <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED El SFR-ATTACHED 11 DUPLEX 0 MULTI-FAMILY-#OF UNITS:- - COMMERCIAL <br /> USE OF BUILDING: 0;--/--ick [iv/42 C_,lO U-5 6 <br /> ELECTRICAL APPLICATEON INFORMATION <br /> CONTRACT PRICE OF WORK: $ / <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT# (if ap licable)7 2- <br /> DESCRIPTION OF WORK: 7- Uex", 6� _5�1+C'E: <br /> CONTACT ONFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> S2/1-) L �/ju 49 p, 14 L <br /> OWNER MAILING ADDRESS: STREET <br /> STATE(/V"t ZIP e <br /> OWNER PHONE: 4-1)Z- S 70 C OWNER EMAIL: fl <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: 51 REET /'v <br /> CITY STATE �V ZIP 1�20��y <br /> CONTRACTOR PHONE: 3-18-2/ - Z CONTRACTOR EMAIL: 13,1e(E7_J_(� -jZ'q'_LS N c---- C r. cc, ,, I <br /> CONTRACTOR LIC.#(REOU]RED): S01_iAj 385/gu CITY OF EVERETT BUSINESS LIC.lt(REQUIRED): 35" <br /> PRIMARYCONTACT; 0 OWNER 10 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 1 ,131?E7- j6,-1A- -S01- CONTACTEMAIL: it <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 Jam 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 1R.27RCV/and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT <br /> Owner/Authorized Agent Signature Date (Revised 101121201,15) <br />