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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P).425-257-8810 j FAX 425-257-8857 f (E)everetteps@everettvva,gov j wm.everettwa.govipermits• <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: akv3v) g-k 5 41 5 C, <br /> BUILDINGAREA(if residential,new constru ion,remodel,or addition) //I I SF <br /> BUILDING TYPE: 0 SFR-DETACHED R-A1TACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> 'ELEdtRicAL APPLIOAtION INFORANATION <br /> CONTRACT PRICE OF WORK:$ 60O 9" <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ° •(" <br /> 1 ,s. ' 4.VIC/7*P' (Ct 'e^*' L 1 (Liu/ '41)Ill ‘':. 4.*''0 ktf <br /> ....,0 <br /> - x •, - , <br /> CONTACT INFORMATION <br /> OWNER NAME: E7: eOrae,.. / f)(„,,,, WV TENANT NAME(If Commercial): <br /> . 121.xf I s+ di e't,-- <br /> OWNER MAILING ADDRESS: STREET '"I'Lly,01 — F L . ,,>C. <br /> p <br /> CITY Ve re, STATE t\ ZIP ftt2C3 <br /> OWNER PHONE: Li 26- 35G --- 54-64 1OWNEREMAIL: 10,„,LW),C1C8 to/Y1.a.r0 <br /> A <br /> CONTRACTOR NAME: ilk-1\ CTYl <br /> t k Ina, <br /> fri,......' '' (....! <br /> --: V <br /> CONTRACTOR ADDRESS: sTREET 110... ,..3- F._ L_I* +- 's .Ct <br /> CITY Arno STATE k)A- ‘ _ ZIP C1c91)5 -'' <br /> CONTRACTOR PHONE: 4,25--744(0 ' 7CONTRACTOR EMAIL: abincio-p6,(fel,Yriet-fe i 447' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):flL-'0 I 22. <br /> PRIMARY CONTACT: 0 OWNER <br /> , 105t <br /> TRACTOR 0 OTHER(Please Specify) <br /> CO CT NAME: , rc CONTACT PHONE: Liir', <br /> 3 ll- <br /> ,..._ <br /> 1.w,i 1m40wcoNTA.TEmAL (iii, of , put <br /> AQREEMENT:I hereby certify that/have read and examined this application and know the same to be true and correct.All provisions-Ohms and ordinances governing this type <br /> of work will be completed whether specified herein or not, The granting of a permit does not presume to give settle*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 thaowner of this property to perform the work for which application is made end! <br /> comply with the State Contractots Law 1a27 RCW and 296.200WAC. <br /> / <br /> / City ofEverett Official Use Only <br /> / <br /> ,, ,c,...__ PERMIT# <br /> / <br /> P. -- 7..7 ( —3--- <br /> illf 7 / E no1- 0 3 <br /> Owner/A(ithorized Aget Signature Date (Revised 9/23/2016) <br /> L.___ <br />