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•LECTRCAL PERMIT A ICATI•N <br /> `44 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 ) FAX 425-257-8857 ) (E) everetteps@everettwa.gov) www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION. <br /> _ <br /> PROJECT ADDRESS: ,77.,C I/ C ('-//) 14f/C <br /> BUILDING AREA(if residential, new construction,remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: S(� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ j_"6o • <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: if, UM ( l 12 (c-/r F k 41/clt e\kif ( Azotv) <br /> /'0s3'//5L P 11114` ,&. • <br /> CONTACT INFORMATION <br /> OWNER NAME: �/t LL(4vt44)6741-/cse_/I '^ /* ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET a,26 J[j i /efI I(/ <br /> STATE tail.- ZIP �"�/ I <br /> OWNER PHONE: y)-( 2_5'2 , a / OWNER EMAIL: <br /> CONTRACTOR NAME: i -'M A-' 14-(Lj 7 ,r j/ l,l <br /> CONTRACTOR ADDRESS: STREET 1(„e C/ { 1/4.:4, - „X— <br /> CITY <br /> — <br /> CIN i�W1 STATE j4/" ZIP 746 / <br /> CONTRACTOR PHONE:112.5 ) z .2/4 i CONTRACTOR EMAIL: • <br /> 666 <br /> CONTRACTOR LIC.#(REQUIRED) CSG CITY OF EVERETT BUSINESS L1C.#(REQUIRED) C9/6 743 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) 67/Tei S <br /> CONTACT NAME: CONTACT PHONE: Zits 2 J/ 2 2 <br /> i,L 00 CONTACT EMAIL: <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 l 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 /> 1s <br /> PERMIT# <br /> )_J E <br /> 0.mer/Authorized Agent Signature Date (Revised 10/12/2015) <br />