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CTRICAL PERMIT 4111LICATION <br /> 'id- <br /> ...7_ CITY OF EVERETT PERMIT SERVICES <br /> viti " 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 /> 1 PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 7 O f a.16(;lAve -c' -e- 11/61-- 9O 2 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHEDn0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: . 0 COMMERCIAL <br /> USE OF BUILDING: 1 �, ' /Q-- 4 Q 5 r U�-rZr 4Q-e / 1-i- �-- ecc 0 /-,e i c <br /> `ELECTRICAL APPLICATION,INFORMATION; <br /> CONTRACT PRICE OF WORK: $ C i) G O <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? -YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): [__ <br /> DESCRIPTION OF WORK: t-t. 4-c J- ;NULs 6 t/'G ode:)( (`--t)ova, qj u..6 �Q' �-A c' i L( <br /> a�r�. 1(o ,r ( Qi& <br /> a /7t//-2 C i jC C-L( 1-1-s 1 k 4-440�Q A`t i loor,4 <br /> R.zwt Q.e ' cot-tit-too ' q ar. 0 (lea/ uicry, eac04o e) <br /> c(vt e .6 3 and ..a/V.4, it4 1-12/0 Lc* f=C <br /> Q.,frl -- c/ czc-< c? e.r O r 11 <br /> CONTACT=1}NFORMATION <br /> OWNER NAME: s- e(1' dt ( "6)QOfC 4Ltv4ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET2_?)0( Cc'/6 ti-"/ <br /> / yn �/ <br /> CITY E/Z . STATE i-"�b. ZIP 22U/ <br /> OWNER PHONE: 7e0 6 3 7 ( a / 6 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: F',OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONT4 CT NAME: 1,4CONTACT PHONE: 760 —6 3 7 % 9 (6.- <br /> c (y <br /> t k k 1 . iPPe. (o 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 /> 1Z - 5c0 <br /> PERMIT# <br /> ._ 4 -. —) // 0 15, 2,,c4 6-- E,1) 1510-015 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />