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"41111P-;:l <br /> L CTRICAL PERMIT AF _ICATION <br /> ►'P y. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everettepsteverettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 7 9 0 9 T t t,,. C i ve C.t_ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED „ FR-ATTACHED El DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: k as`,w <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /.S00 o CO <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES +110 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> R><PL- a AviA.P ZW:SC2 PAOCAD Ci-LA 0 <br /> JOS c Wit_ 7 ^ G,60 L A)JJ 0-014 S r /LSO iJ cf-c.0 GC .' <br /> CONTACT INFORMATION <br /> OWNER NAME: Ai)Avv'1, kkC44i l__ F.r410c OAAICEPaNT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREET 7 9�op9'q mt vv1.t3ay& <br /> crry ��1.� STATE l•-•94 ZIP R o2s--U <br /> OWNER PHONE: Z., — 7oZ- - 7'-{3 3 OWNER EMAIL: <br /> CONTRACTOR NAME: R..gt. <br /> CONTRACTOR ADDRESS: STREET O V 4 -7 N W t7 -r&(- -St <br /> crrY (,- L.wZ STATE t wA /" ZIP I c � <br /> CONTRACTOR PHONE: 20(o- 9,x(9"-5 CONTRACTOR EMAIL: r L�1< q �"�( e U1.ott is( , ,,vt <br /> CONTRACTOR LIC.#(REQUIRED): 'R6tiyt„Iic3c 7 JCITY OF EVERETT BUSINESS UC.#(REQUIRE' : 0.5.3 56 I <br /> PRIMARY CONTACT: OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: j(o_ CV-{ct $.6'3 <br /> G" CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that t have4ead and examined this application and know the same to be true and correct. A1.provisions of laws 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 authority 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 the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 298200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> )2.,LA 11r �-� E LCC - c(Lo <br /> Owner/Authorized Agent SIgnatu Da (Revised 9/23/2016) <br />