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LECTRICAL PERMIT ABLICATION <br /> I�►��r�- 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 www.everettwa.gov/permits <br /> PR-64E-0' SITE 1ORMAT,LON = - <br /> x . <br /> PROJECT ADDRESS: Z-cZZ [ J� 1 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) 2-4)\ 1 SF <br /> BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> xirt If40CTRIcAL'APPLIC ATION INFO VMATION ' k .. ; <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): I <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> DESCRIPTION OF WORK: ("A.CI 1 trCi14,1 t v' A- 1 ( G'LG11c4. (Y \ <br /> �/'' <br /> CONTACT INFORMATION <br /> OWNER NAME�)&I/\ L. 1?)t' y�TENANT NAME(IfCommercial): <br /> OWNER MAILING ADDRESS: STREET ?j 2 (�, -}{I—S 'l P \ GAF �A �/-�} <br /> CITY �/'Fre-A/-61-4--- <br /> ,/�/ ��l./y 1 c [ �,STATETEV V" ZIP 9 02-63 <br /> OWNER PHONE: f 32,1 i5? P OWNER EMAIL:t1/�'{1��' t'� `�I.t- a- C uh - + (j <br /> CONTRACTOR NAME: (31, P1 C 1 '2 c7 <br /> CONTRACTOR ADDRESS: STREET <br /> 1 1`I�`�-l��pmt 2-2/0 1-1-1 Y�O�1/���> J 4 r \ }/� <br /> CITY 1 - `°U "` �O`, "�C/' • e1LCS- STATE �' ` ZIP <br /> CONTRACTOR PHONE: c-i11 1 13cA CONTRACTOR EMAIL: I ttI,� ablAt(�l�nkV C-f-)►1/\ <br /> CONTRACTOR LIC.#(REQUIRED): G PP S 2 tfCITY OF EVERETT BUSINESS LIC.#(REQUIRED):tCl <br /> PRIMARY CONTACT: vOWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> C NTT CTNAME: <br /> A CONTACT PHONE: L( 2 c— <br /> t/v' \1 V\/ IN/N.A 12i CONTACT EMAIL:cca3 Vim- <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 /> t4t 6°"*".' <br /> PERMIT# <br /> � l l t 1y E l " 6(02) <br /> Owner/ or ze gent Signa Date (Revised 10/12/2015) <br />