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4110 <br /> ELECTRICAL PERMIT AL ICATNON <br /> Niiiw"Ij--1 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwagov/permits <br /> PROJECT SITE I+I i RM`,TION <br /> PROJECT ADDRESS: 5C' (3 J C v --Jo L , e <br /> BUILDING AREA(if residential, new construction, remodel, or addition) ° 0 SF <br /> BUILDING TYPE: ❑SFR-DETACHED ISYSFFR-ATTACHED ❑ DUP EX ❑ ' LTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: ieE'<i b j e c'(,._)C <br /> ELECTRICAL APPLIC TION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 15 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES WINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): _ <br /> DESCRIPTION:OF WORK: >4 4d,c'-(-I eco 5 7-4.,? c-- _. ''' ?/4/2-51- �' (-' - _ <br /> p,, 12p-)-1. w7-1-1 tor44-h1.40O t. <br /> CONTACT INFORMATION <br /> OWNER NAME: L 11 )4,:,-/__ I c c-' .k.,)v(e,2,5c",)TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5o ( 3 5 04_6 v,4 /-4 c c <br /> crrr rLJ< ±( STATE (:_/1--)‘=-) ZIP G '8C. <br /> OWNER PHONE: "'i". 6---'31--/f3--- '?D C".3 OWNER EMAIL: <br /> CONTRACTOR NAME: /4C e/Z k-. ((c.-f a2c ( ___LcC <br /> CONTRACTOR ADDRESS: STREET l(3 l7 ...V44 4 e Se- <br /> CITY V Q42... STATE Gi_ i. ZIP /t8R <br /> CONTRACTOR PHONE:405'33C5-((c95 CONTRACTOR EMAIL: /4C ..___e(eG r c.)?t-1-14'_„,„tgi <br /> CONTRACTOR LIC.#(REQUIRED) (.4C Eiz 6 J_ (y 1. CITY OF EVERETT BUSINESS LIC.#(R UIRED) (---(o0*-_,) <br /> PRIMARY CONTACT: ❑OWNER IJzI'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: \---"--,.“-,,L3 CONTACT PHONE: 41a Ss—j 3 c> ((8_5 <br /> CONTACT EMAIL: <br /> AGREEMENT.'Thereby 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 tam 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> . V)e ----- <br /> PERMIT* <br /> 0 AAuthorizedAgentSignature Date (Revised 10/12/2015) <br />