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01/16/2018 09:22 #3104 P. 002/002 <br /> 4:77 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 1 (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SITE.INFORMATION _ <br /> PROJECT ADDRESS:2/l � 4- S —.-- <br /> 0 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED- A DUPLEX Q MULTI-FAMILY-#OF UNITS: Q COMMERCIAL <br /> USE OF BUILDING: C ACJ f M 61 J7-1 of ---. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 34500 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES CI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: f_ / - <br /> m Al 7 6 C A . • • 't i // ,tom A , <br /> CONTACT INFORMATION <br /> OWNER NAME: fMC¢ is C iAiremJ E _ TENANT NAME If Commercial : <br /> OWNER MAILING ADDRESS: STREETA J/X .37 JT •' <br /> r5 L CITY 4 STATE /'/_V ) �- I <br /> OWNER PHONE• Yi OWNER EMAIL: <br /> CONTRACTOR NAME: L A/GI�IfGh f/I��-� IU/ e • <br /> CONTRACTOR ADDRESS: STREET • / _ L .f /✓: .�� •' <br /> yy `I�/A�� �• �. <br /> Cmr_�i.��i►..�- +L 4 &TATE /IA/7+ ZIP <br /> CONTRACTOR PHONE J )!9 f� / ,CONTRACTOR EMAIL: J� Y r7 <br /> CONTRACTOR LIC.#(REQUIRED): G, �uS1 / 2.I j' CITY OF EVERETT BUSINESS LIC.#(REQUIRED); <br /> PRIMARY CONTACT: 0 OWNER Q CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 9'2J <br /> C5-81-11.) (,. CONTACT EMAIL: <br /> AGREEMENT.'I hereby earthy 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 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 I am authorized by the owner of this property to perrorm the work for which application Is made and <br /> comply with the State Contractors Law 18,27 ROW and 296200 WAC. <br /> • <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (e F \SO -- �--- <br /> OwnertA orizod Agent Signature Date (Revised 9/23/2016) <br />