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#11/IP _ECTRICAL PERMIT A_-LICATION <br /> 411 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: 2 2,© 1 1 0 0114 &'f Lj4",1 <br /> BUILDING AREA(if residential,new construction, remodel, or addition) SO 2-Lt SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: (.COMMERCIAL <br /> USE OF BUILDING: t Cpryl p I^ i •- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ,‘„c) © `'e_ <br /> NUMBER OF DEVICES (if low voltage),l ..�---- <br /> FIRE ALARM? 0 YES L�uO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): n <br /> DESCRIPTION OF WORK: iL�G`T�I C_ONL- \=OyZ.. Or P I C_.'� K.Q.n1 O o L. <br /> CONTACT INFORMATION <br /> OWNER NAME: J—► U( 494.A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .7 Z ) C)CD 01 `j-- _ ',` J } <br /> CITY J aG 1T STATE W�^ ZAP `3 <br /> OWNER PHONE: ti-ZS." 3 l - CQ: OWNER EMAIL: <br /> CONTRACTOR NAME: r`e..4-A,s CAL- <br /> CONTRACTOR <br /> ' L .CONTRACTOR ADDRESS: STREET p. <br /> c . . (.6Cr)( df t+ <br /> I <br /> CITY V "G(W- rr ,STATE v_" A ZIP <br /> CONTRACTOR PHONE: Li'Z'S-' , —Z I CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): ► j � '7 1Pez-- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): /6 0 <br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'T( ' —249s--7 <br /> l ( (7-k.2Ass ON) CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that t 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 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �oS . 00 <br /> PERMIT# <br /> E (coq. <br /> -0 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />