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E=-CTRICAL PERMIT AP (CATION <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: C 075 uO. M i t:i V c _r' 1�-`o <. <br /> BUILDING AREA(if residential, new construction, remodel; or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: a �?_.�/ Li%[; (a + �= _ 0> <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ t <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES jkNO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: A 1 '71 _=_° Avr-t_�' €C <br /> f cv P� N7(--C�-= C C t t i� n! r' -t C'cS GC E F' �« L: 1' `•V C (LC <br /> L c . -" y rr `' i` bt�ytC;A760 'PLL 11S Ls 7 <br /> - 'tt=r_i '1 \e-(•;^�ZI(,;.F.�'h:�,,� � l��tti �(�1\ , 'c":ttF_--.`�_ Ne-i— �OC� 1�%c'ilc� '(< <br /> G_/V i E t1 '0 ?.0 G a ( JZZ C Ftp, ii-C�;.ti.�a !��"z J�x� T"v: z S c f- �!-�ARtr►C ���i j2 <br /> CONTACT INFORMATION <br /> OWNER NAME: T �> l4 L tZ-E;1,L E5 fi-TC- TENANT NAME(If Commercial): kT 04(C C C �32C tt%C 1� <br /> OWNER MAILING ADDRESS: STREET �� / C i <br /> CITY L 0 CZ it-c- `r I STATE tA-i.) ZIP <br /> OWNER PHONE: q'2_15 Z S 2- ` .-Io '� OWNER EMAIL: <br /> 7 <br /> CONTRACTOR NAME: Cr- "�� t-lc ' 2i e- +et e, <br /> CONTRACTOR ADDRESS: STREET l\ �C PL.q IL Lam:, *� <br /> CITY L Y N N L'`'0 o b STATE LI-) ZIP CVC-3 <br /> CONTRACTOR PHONE: << �� ��c{�� t r1CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): G�- C � `I s��r_`�i CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �j1LL6-C. c <br /> PRIMARY CONTACT: ❑ OWNER ,(CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'Z_Lit <br /> O C l C C� A alt 1(S CONTACT EMAIL: c c'. `c '&-c a, 5 <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 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 /> Z/650 OL <br /> PERMIT# <br /> I �OZ - l� Z <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />