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S <br /> OLT ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2-9/6) — ( OCT~ S T 5 r= <br /> BUILDING AREA(if residential, new construction, remodel, or addition) " C:2 SF <br /> BUILDING TYPE: El SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: S F <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES El NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ll <br /> DESCRIPTION OF WORK: t t.s CC :. 3 nt..; fc, DC( (C,N (Feat 1=-e(Cy' f' C',tJ <br /> - 6_3 C RC'�l Cj <br /> c(VLC-C41 l <br /> CONTACT INFORMATION <br /> OWNER NAME: ,j SFE 4 F.tAp.y Ge,R)1Q TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z 9 ((v (O c ,s r $'-F O <br /> CITY Evav2-Q(( STATE �' l'[ ZIP / PI 2 Q <br /> OWNER PHONE: Yeti 37 Y-- 5 "79 OWNER EMAIL: <br /> CONTRACTOR NAME: /L( CC.,( C Y gt-a--i IZK_ Cv (L <br /> CONTRACTOR ADDRESS: STREET 3 5 (5 S((--E c:02-( S <br /> CITY Eva STATE 150 ZIP y e <br /> CONTRACTOR PHONE: y A j 3 -Q f - CONTRACTOR EMAIL: M L (.17)( i�t=C l R(i . l� (>k((.— <br /> CONTRACTOR LIC.#(REQUIRED):i Cl7(1J EL,6r,3(V J CITY OF EVERETT BUSINESS LIC.#(REQUIRED):© 38 3c{U <br /> PRIMARY CONTACT: ❑OWNER .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: cf a5 CONTACT PHONE: SIttst,ta <br /> Mk(\Ick t•-tL7((--(X —C)(c)93 CONTACT EMAIL: SX <br /> AGREEMENT I 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 type <br /> 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 /> PERMIT# <br /> E 1107- H7 <br /> 0 'Fier/Au orized A. :nature—--` Date (Revised 9/23/2016) <br />