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�LECTRtCAL. PERMIT AP�LICATlON <br /> cxxX a������r���a������v���s <br /> 3200 CEDAR STREET, EVERETT,WA 88201 <br /> (P}425-257-8810 � FAX 425-257-8857 ( (E)everetteps c'L'r}everetiwa.gov� www.everetkwa.gov/permits <br /> PROJECT SITE-INFQRMATiON <br /> PROJECi'ADDRESS: /I,3d � L:EE% M LG Y OS( <br /> BUfLDING AREA{if residentiat,new construction,remodet,or addition) SF <br /> BUILDiNG TYPE: ❑SFR-DE7ACHED ❑SFR-ATTACHED C7 DUPLEX Cl MULTf-FAMILY-#OF UNITS: COMMERClAL <br /> USE OF BUELQtNG: �QG�Li I <br /> EL�CTRICAL APPLICATION INFORMATtON ~ <br /> CONTRACT PRlCE OF WORK:$ 8' <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE AIARM? ❑YES �NO <br /> ASSOCIATED Bt11LDING PERMi7# if a licable : <br /> DESCRiPTIC3N f3F WQRK: t�l 0 � � � <br /> � aQ � � 1 <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commerciaf: l�L�S� tJ <br /> OWNER MAELtNG ADDRESS: srneer <br /> � STA7E �P <br /> OWNER PFtdNE: OWNER EMAIL: <br /> CONTRACTOR NAME: � � LT�I/r � <br /> CONT42ACTOR ADDRES8: s��s f 6 —' t�' d= '� <br /> � G n�o 7`N ��,� n�y rP.�i�/6 <br /> CONTRAC'COF2 PHQNE: �/ - -.�SyY canrr+eac�ra��nRart. MG� . <br /> CQNTRACTOR UC.#(REQUIRED): �/VG'Rr+/Dt G-�'.�i'Q IC�G Ci'i"Y OF EVERE7T BUSItJESS LIG.#(REQUIRED):C�33 7� <br /> PRlMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: GONTACT PH4NE: F'j f a--7C�/p— 3��y <br /> t?'Ifr77f/�y G�t�4� CONTACTEMAIL: YM IiNM�� �rrt G GGG. CD�+-, <br /> AGREEMEMT.-i hereby certify that i have read arrd examirred thrs appfica6oa antl krrow the same to be irue aRd coaect. Alt�xavisiuns af/aws aod ord'+nances goveming#his type <br /> of work wift be compleYed whether speaked heieirr o�not. The gran6ng of a permit does not presume to give authwily to vio(ate ar cancel the provisions of any othersfate or <br /> foca!!aw regutafiirrg e4rrshuction or the pa�fisrmaeTce of cortstruction. 7hat I am authorized by the ownet of this properfy to perfamr the strork tor which appiicaffon is made and 1 <br /> campfy with ffte Sfate Gontractors Law 18.2T RGW and 29fi 200 WAC. <br /> City of Everett Otficiaf Use Onfy <br /> PERMIT# <br /> . .q ,� E ��� I l�C� <br /> Owr�er/Auttwrized Agent Signatu Date (Revised 9/23/20f&) <br />