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„iv ILECTR CAL PERMIT AOHLICATION <br /> miliwtCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: /672_c, -2,is r 751. (A) , tiered t C A)c=. <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 5 e 0 <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): j <br /> DESCRIPTION OF WORK: 7M:,twll died- ca` A,( AC 4- <br /> CONTACT INFORMATION - - <br /> OWNER NAME: 60 GIA)frL y 1.);Ne..tivoAxisety TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /07'26 4 74 71'”" j L (4 <br /> crry hveret, STATE WO ZIP 616.20 I <br /> OWNER PHONE: // �--� OWNER EMAIL: <br /> CONTRACTOR'NAME: ?VLsk R7ectri LCI 4Airr tt 1t ClAd be.ci yl v <br /> CONTRACTOR ADDRESS: STREET -2,2C C1 CleCw .CGS r 7?-1) U �9 �j �i <br /> CITY CK S/xv i"S i STATE <br /> �j CL ZIP �O Zsa <br /> CONTRACTOR PHONE: 3GO q � 00/f CONTRACTOR EMAIL: ideS[�ythdribi4() 6' 4ma.e y,eryt." <br /> CONTRACTOR LIC.#(REQUIRED): Ii,..0ejEC ..Ci a- CITY OF EVERETT BUSINESS LIC.#(REQUIRED).05660. _w <br /> PRIMARY CONTACT: ❑OWNER [g CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTaNAME: b / <br /> CONTACT PHONE: --. 60® 'C/ c©/l <br /> 1V CL�2/CV CONTACT EMAIL: iNkes fC died'i 4'e06-67�✓ d(t <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true ancccorrect. All provisions of laws Ind 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 /> f <br /> r <br /> PERMIT# <br /> cz�� i El b0-2ZI <br /> 0 er/Auth zid Agent Signature Date (Revised 10/12/2015) <br /> 9 9 <br />