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ECTRICAL PERMIT AFICATION -- 1 <br /> "j"-i <br /> CITY OF EVERETT PERMIT SERVICES -- <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION 1 <br /> PROJECT ADDRESS: tai ked., (.7 ' in or-) ) -I AV'€. Unit� (3 <br /> BUILDING AREA(if residential,new construction,remodel,or addition)reS LTter)--)cL ( SF <br /> BUILDING TYPE: 0 SFR-DETACHED D SFR-ATTACHED `l '}UPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 2 c,(1f 4-'1,...,1' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1 5 C <br /> NUMBER OF DEVICES (if low voltage): / 3 <br /> FIRE ALARM? 0 YES `IAO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 16 JC ‘i Y`l SPC cur t--f-L) 0--4d Sk1,k_i(-.v i I <br /> CONTACT INFORMATION <br /> OWNER NAME: 01,i-CIO10 '/ )l aY►' IE S j V TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET � L` 1 -j j S+ e ,� <br /> CITY E i�`� i STATE W A ZIP /8::.:).0 ---- <br /> OWNER <br /> c -- <br /> OWNER PHONE:rice -338 - 1.154? OWNER EMAIL: <br /> CONTRACTOR NAME: Al(A ) S7pC.bt,..r/j'-f'L-1 6.:7,-,v-vd o t...A.-y\c\ <br /> CONTRACTOR ADDRESS: STREET /43LC8 / ca, °"` L/�� �/ J�yj�} <br /> //}} CITY `�t'-tQ�0{'Y1 t STATE L.,(),0 zip 18t;ciU <br /> CONTRACTOR PHONE: C' ' CV 7 l' ` 4-4,2a.::;CONTRACTOR EMAIL:)PQ /{J(,L6eit-Yr- Ct•vvt 561�-cJ- b t ?Z.. <br /> CONTRACTOR LIC.#(REQUIRED): /01,0S EC-S9 f c Ri 7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C.)Q :-/j <br /> PRIMARY CONTACT: O OWNER 0 CONTRACTOR `?THER(Please Specify) <br /> CONTACT <br /> 1NAME: <br /> . ��/j CONTACT PHONE: (. O/- j ..- 11 ,Q- O j <br /> (Nay)t 1. )G` i( CC vv `.S CONTACT EMAIL: ?r =Jt(CL t jai 'etcy, -iC - c <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 I 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 /> 4 1 5 0C) <br /> I ` / PERMIT# <br /> AcC i J /.// _ LY/ Et, I ‘,0(-1-- 00(5 <br /> Owner/Ad honzed Agent Signature Date (Revised 10/12/2015) <br />