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4ren. E ECTRI CAL PERMIT AP _ICATION <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 <br /> PROJECT ADDRESS: ( i 5 CcSca r. Orwc v- ' � �c lay Y-Z-co <br /> BUILDING AREA(if residential new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL 0 INDUSTRIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ y o c- <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> DESCRIPTION OF WORK: ( , t it A+ �L L ? �t z-r i .' I -ri (:- ) c <br /> /� CONTACT INFORMATION <br /> OWNER NAME: 1' +v, Q TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr i 2- t S Com.s«d <br /> CITY 6 vc r"-t j STATE A ZIP 9 S w;3 <br /> OWNER PHONE: c.sLS- Z 9 0 • 1 L1 Co 4 OWNER EMAIL: <br /> CONTRACTOR NAME: k L Y,,,-eq 5 <br /> CONTRACTOR ADDRESS: STREET 9 S w Wer c4 c L_ Ic C) 4r- <br /> CITY <br /> r ,,.r�11 <br /> CITY S fL} Vv.:: �� STATE W A ZIP qJ 2A U <br /> CONTRACTOR PHONE '3(o p. S $ .0 ( (o-L '!CONTRACTOR EMAIL: <br /> -CONTRACTOR LICENSE#(REQUIRED): K vv. E f+ aC oU k C. f' CITY OF EVERETT BUSINE` LICENS- #(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ([]`CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 33t3 ' . - 3 0 •1 S Z 3 <br /> C., - r_ ( CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that 1 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 /> kc% - kms E 1. (ZOC ( 2 <br /> Owner/Authorized Agent Signature 1 Date (Revised 09/25/2015) <br />