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/I 211W LECTRICAL PERMIT AtElICATI®N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT S1Tl� IIoIFORtV1AT10N <br /> PROJECT ADDRESS: 4P1.33 ,c C4 t/4 4 day Q ' gZ-72- <br /> BUILDING AREA(if residential,new construction, remodel, or addition) Z S SF <br /> FUS <br /> UILDING TYPE: E]SFR-DETACHED E] SFR-ATTACHED 11DUPLEX ElMULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> E OF BUILDING: <br /> ELECTRICAL:APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): 2V©!t.! ' to t <br /> FIRE ALARM? ❑YES <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT,IN FORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDR SS: STREET 42 ,CQ 4 <br /> O!!ArD t My STATE �"/ ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: vC/��m a rj ct <br /> CONTRACTOR ADDRES : STRE 7 evc c.Le <br /> J�2 <br /> Le:�tt CITY �+ STATE (��� ZIP 2Q <br /> CONTRACTOR PHONE: -QZ -1 CONTRACTOR EMAIL: CAk�<62 <br /> a <br /> CONTRACTOR LIC.#(REQUIRED): C CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 39ZONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:IL <br /> CONTACT EMAIL: , <br /> AGREEMENT.-Thereby drtify that 1 have read and examined this application and know the same to be true a 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/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 taw 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE �> <br /> v v <br /> PERMIT# <br /> C-71 E nD-3- �H <br /> Luthor�i,z."dAglnt!Siq=..ature Date (Revised 90/92/2015) <br />