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1047r ELECTRICAL PERMIT APPLICATION <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.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: il v„,,.. g 4..c.6=eA- 4tc <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ G,) Orao , OD <br /> NUMBER OF DEVICES (if low voltage): A) 4 <br /> FIRE ALARM? 0 YES XLVO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 9,QAmt,pJJ , C,t„cl `-e„()k,-•&c_ i(vVAA/( c, <br /> r f 6 e ` d .�z L— 4-, <br /> P <br /> I <br /> CONTACT INFORMATION <br /> OWNER NAME: /Qy-/ Ra.6eJ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Li <2 LZ )2 c., %N J e ^C� <br /> CIT,Yt� e,/,r-e-f'�” STATE CA)* ZIP 91 2-0 <br /> OWNER PHONE: ! Z5- (C/ / / / 2- OWNER EMAIL: ,�J/f <br /> CONTRACTOR NAME: 60-714/? JZ44. L S�1� Clic/ / "! 171, <br /> CONTRACTOR ADDRESS: STREET /57)1 P 10 `J/2,. ue__ <br /> CITY 54,0Y`eryl/l. ✓k STATE Cd ir ZIP 151 2 Cl O <br /> CONTRACTOR PHONE: 36,,e) g(, 3 Co.?051CONTRACTOR EMAIL: 705Ottlitetret e_--61/14 /A(A) , COW( <br /> ( <br /> CONTRACTOR LIC.#(REQUIRED): COY,A/W\EC.'V 15302, CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0 Z.-7 n Li <br /> PRIMARY CONTACT: 0 OWNERCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> �NA'ME: l CONTACT PHONE: 4 2,5 f� 7/20 ( /c/( 7 <br /> �J V lµ (� 4. CONTACT EMAIL: 50tH) �i @ CG�gn 0 ' J ^' <br /> AGREEMENT:T hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of faws 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 lam 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 /> .) <br /> 4 I.O0(nJC% <br /> PERMIT# <br /> lid 1 EIS -O(7 <br /> Owner/Authorized Age•t`nature Date (Revised 10/12/2015) <br />