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LECTRICAL PERMITIT#PLICATION <br /> J_ <br /> CITY OF EVERETT PERM _RvIcES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E) everefteps@everettwa.gov j www.everettwa.gov1permits <br /> `4 <br /> WEI <br /> PROJECT AD.DRESS: Po rL I <br /> \Ij <br /> BUILDING <br /> UILDING)ING <br /> AREA(if residenfial,new construction,remodel,or addition)_ SF <br /> BUILDING TYPE: 0 SFR-DETACHED [I SFR ATTACHED 0 DUPLEX El MULTI-FAMILY-#OF UNITS-- F1 COMMERCIAL <br /> USE OF BUILDING,. <br /> PP <br /> -a.w <br /> CONTRACT PRICE OF WORK-$ <br /> INUMBER OF DEVICES (if 10W voltage). <br /> FIRE ALARM? 0 YES <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> DESCRIPTION-OF WORK: <br /> ... ....... <br /> COLI'TAC <br /> 0 <br /> TENANT NAME(if Commercial): <br /> .()WNER NAME L-.-_t' <br /> Q A C 5L, <br /> AQ <br /> fOWN.ER MAILING ADDRESS. sTREET 5C 14-4 k <br /> .1 ! Crry Jr Zip <br /> Ai STA <br /> OWNER PHONE: <br /> CONTRACTOR NAM Doac�( J <br /> CONTRACTOR ADDRESS: STREET?- 0 . �)".0 STATE 7JP9 <br /> My 5-e W14 1 - <br /> L4Qr­3_5-�— ]CONTRACTOR EMAIL: aac-'J� <br /> CONTRACTOR PHONE: ()H16 <br /> GONTRA,CTO.RLJC.#(REQU1PE1D)- CITY OF EVERETT BUSINESS LIC.#(REQUIRED); 0 <br /> PRIMARY CONTACT. El OWNER XCONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 41 a321� <br /> CONTAGTEMATT- SSZ tj cc � IC4A ( ,P'l <br /> AGREEMENT.'Thereby cerfifythat/have read and examined this appricaffon and know the same to be true and correct. All provisions of laws and ordinances 9OVeming this <br /> type ofwork will becompleted wbetherspeciffeciherein ornDt. The granting of permit does notpiusume to give authoiffyto violate arcancel the provisions ofany off7erstate of <br /> local jawregulafing construction orthe performance of construction That I am authorized by the owner of this property to perform the work forwhich application is made and I <br /> comply with the State Contractors Law 18.27RCWand 296.200 WAC. City of Everett Official Use Only <br /> FEE <br /> �q C70 <br /> PERMIT# <br /> 11 <br /> ouvner/Autfi-onized gentSignatureDate (Revised 1011212015) <br />