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47ffir LLECTRICAL 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: 52 0 5.e v ek'1y 1-/7, <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 6 SF <br /> BUILDING TYPE:XSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Aux. ( hop) <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 12.00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 7(440 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): (! 6 07/ ^ CO <br /> DESCRIPTION <br /> tttOFWORK: get,/c.0 .-er(///)'C - ep,''f1-.. 'm/C-(qe� y`p�/,`�� t7 Of <br /> 20 i`idC y Li 1 1 h Qb. =1-4 �'-''co.1V C-9-ec k' (?rd$ 1 / c us . <br /> CONTACT INFORMATION <br /> OWNER NAME: J- fr.t.t7/ G,P jr f SO LA. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '2O' ' 13.e a/ h 17 t.ii, � / <br /> l,r-eft CITY 1414k. STATE 96,203- v/ ZIP <br /> OWNER PHONE: 1/25':32V"-Til6/ OWNER EMAIL: 1.t &4vl^te5/- 7 l� 7t.00tn <br /> CONTRACTOR NAME: , .(,(j/? e)-- <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: *OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: I- CONTACT PHONE: 4125-_ 42€- 6 <br /> J-ej^/'( !�/-)^I Gk5"df// CONTACT EMAIL: j el^l'y 0ec,rr-esf'ef"'1)1S^hVI71-e't .cd/in <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 if <br /> IO®o°0 <br /> PERMIT# <br /> "7., /' /�/Date E fe l2— \Li% <br /> Authorized Agent Signature <br /> n fDate (Revised 10/12/2015) <br />