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•ECTJCAL PE M T AP••CAT N <br /> -.- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 J (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 02CJO 7 V ‘rA h j ek- <br /> BUILDING AREA(if residential,new constr'?ction,remodel, or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED 1a SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION- <br /> CONTRACT PRICE OF WORK:$ c25O,00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? El YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: S 1� U` U ci�,.�,� d) L' t- CcV L •% t C- <br /> : _ <br /> CONTACT INFORMATION. <br /> • <br /> OWNER NAME: E ct 61V-C. W oo fY TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smear 0209 5 V Y6 k‘e\-CA /�✓ <br /> CITY elf aft- STATE 'fr 4 ZIP qS;' ' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ---Tivrt-\ d A/e.,:\kcS. <br /> CONTRACTOR ADDRESS: STREET \7)'d-co, 16.\-`1 SY" S i v <br /> crry CV 2 r STATE w(1 ZIP q kdOki <br /> CONTRACTOR PHONE: - YO-2' 2 CONTRACTOR EMAIL: S q✓'V CG LGA - <br /> CONTRACTOR LIC.#(REQUIRED): Tlfi y S Ps 4(.1 )O80 CITY OF EVERETT BUSINESS LIC.CREQUI• D). f( <br /> PRIMARY CONTACT: El OWNER6ONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: ll CONTACT PHONE: ,( — U — <br /> V /e c L( 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 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 /> PERMIT# <br /> r- ,.6001.1W 300 E n-03 _ oz(o <br /> Ow er/Aute. -.Agent Signature Date (Revised 10/12/2015) <br />