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�LECTRICAL. PERMIT � LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320Q CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everetiwa.gov� www.everettwa.gov/permits <br /> _. , ,_< � _ <br /> ` •: PROJECT SITE INFORMATION: ` � <br /> PROJECTADDRESS: J 30 �] �" �jTGZ�T � <br /> BUILDING AREA(if residential,new construction,remodel,or addition) F <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED ❑DUPLEX ❑MULTI-FAMIL - F U ❑COMMERCIAL <br /> USE OF BUILDING: P_>-ASE-r'"�C� l�{�(�6Z A j�� <br /> � .. t _. , . <br /> - , ; <br /> ;; ELECTRICAL APPLICATION INFORMATION; <br /> _: _ ..�. . _.� .,.��,. . ..;.. . <br /> . ... .. �.. . a � .. ,: ... .� <br /> CONTRACT PRICE OF WORK:$ J`O 6 °`� � <br /> NUMBER OF DEVICES(if low volfage):• <br /> FIRE ALARM? ❑YES CI NO <br /> ASSOCIATED BUILDING PERMIT#(if appiicable): <br /> DESCRIPTION OF WORK: YV : � E L�GT� �C� Z- P���� <br /> P��A -� Lr G �'rS �� O v�LE`�`S Su� t�L�i�� � � nr 4��JS���� � <br /> _ . ,. ,. <br /> ,. <br /> CONTACT INFORMATION <br /> OWNER NAME: '!`A?(-�VI S �l' S�'l�G� TENANT NAME(If Cammerciaf): <br /> OWNER MAILING ADDRESS: s�te� �`3O 7 �� j�f'22�' S� <br /> CITY �V�fZ'L� STATE �'` ZIP /g�O <br /> OWNER PHONE: L�2 � ��IC(� ��p� OWNER EMAIL: m v k� ��-ed J�2� e„�10/. Com <br /> CONTRACTOR NAME: �t—�" <br /> CONTRACTOR ADDRESS: sraeer <br /> CIT' � STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �2 rj ���• ((p Z3 <br /> T��Vl S '\ S�l�C��(��t�6 CONTACT EMAIL: {"n V k i I�D J�2 l e a o I• CD 1Y1 <br /> AGREEMENT.'T hereby certify that/have read and examined this app/ication and know the same to be true and correct. All provisions oflaws and ordinances goveming fhis <br /> type of work will be completed whether specifed herein or not. The granting of a permit does not;oresume to give authorify to violate or cancel the provisions of any other stafe or <br /> foca!law regulating construction or fhe performance of construcfion. That!am authorized by the owner of this property to pertorm the work for which application is made and 1 <br /> comply with the Sfate Contractors!aw 98.27 RCIN and 296.200 WAC. <br /> Cify of Everett O�cial Use Only <br /> FEE <br /> . �� �_ <br /> PERMIT# <br /> l� �Z- o-�-�o�-, E ��Z - 03 � <br /> OwnerlAuthorized Agent Signature Date (Revised 10/92/2095) <br />