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*LECTRICAL PERMIT AOOLICA`fION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E) everetteps@everettwa.gov 1 VAw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: A V t UC;Ctk IA;A <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 11 SFR-ATrACHED 13 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ b 0C')0,u" <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: _')S{ti 1 l nu-)O,�k lJr Cc !<c� I G C "U„ i p <br /> C G:v�CJt W; a_ <br /> Jl�t.� fit G s �;mac; r Lw ; z <br /> Gh c,rt L jYj �� pp S-:%je C ,,.L5 t c5sar-, <br /> CONTACT INFORMATION <br /> OWNER NAME: t��av dtt he( ; � TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: sTR?Er <br /> CT( <br /> sTA.T-� zP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (�^�L <br /> CONTRACTOR ADDRESS: s REEr <br /> STATE 1"(' nP <br /> CONTRACTOR PHONE: 24&,,--g3&_ 20C) CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): AN Q � <br /> __. _.._____...___ ....__.___... �_.,.....,,_._..._ .... ......__. -..._.-_-.._.___._._ . ._._....._....._..,CITY OF EVERETT BUSINESS LIC.#(REQUIRED):00L19 S <br /> PRIMARY CONTACT: ❑OWNER `CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> � Zat� <br /> & '� I CONTACT EMAIL: <br /> ACREErYFVT. Tr.•erec ce _ - �J� �C4O&jKt qC1 UtC .Cc.£-I <br /> y rfify that/have sad and examined this application and know the same to be true and correct A//provisions ofJaws and ordinances govaming this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to <br /> give authorityo viciee or cancel the <br /> local law regulating const!,lction or the perfonrance of construction. That t am authorized by the owner of this propel too perform thew for h h application made st at or <br /> comply with the State Contractors Law 18.27RCW and 296.200 WAC. <br /> Cry of Everett Official use Only <br /> FEE <br /> �! PERMIT# <br /> 16 <br /> 0 eriAuthorizedA ntSignature <br /> Da' {Revised 10/12/2015) <br />