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0477- I _CTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> G '* ° r <br /> PROJECT ADDRESS: I I 15 P A-(.‘i\\ • it. t, 'v'e ries Y J A '» - <br /> BUILDING AREA(if residential, new construction, remodel, or addition) HU 2-J6 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX \.61.4 MULTI-FAMILY-#OF UNITS: � 0 COMMERCIAL <br /> USE OF BUILDING: ),,S,:not, Au,- -v) / <br /> CONTRACT PRICE OF WORK: $ " ) (1) , ot ) <br /> —NUMBER OF DEVICES (if low voltage): D <br /> FIRE ALARM? 0 YES LZi NO .() ' ' (-(),J1 Lkk0 nnl (`L( <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: Ljc `r- i YVc It'?' '04^•rI - <br /> :, n rrlwiv .,nf yi.•.y ( a ;4e:,v,- t i 1tryj <br /> ows , <br /> S .. 4v 9 ',. <br /> OWNER NAME: 1 v'e V - -t \-c i A /\ a ENANT NAME (If Commercial): `c. lY u <br /> 1'.� <br /> OWNER MAILING ADDRESS: STREET O -_ - r � _ <br /> CITY . .:%[ ' it STATE \v ZIP CI 32- -if <br /> OWNER PHONE: L12c ' f' <br /> )� LZE,� ` 'y� OWNER EMAIL: <br /> CONTRACTOR NAME: SJJ-f~'1'11 �-G1�(Atl il,s. %`4. tVV(`l r•)/ed l't1' ri- _. <br /> CONTRACTOR ADDRESS: STREET t� )k' C_) )-)`(S �! t <br /> CITY „k V—\ Q "\ STATE \NAZIP C \f ' <br /> CONTRACTOR PHONE:k2 5)iI..I 2,61 CONTRACTOR EMAIL: F1(I'T:1%J4€ SL/ -1 1ii J JI1,k,-t-oiri;•WC' ,( IA. <br /> CONTRACTOR LIC #(REQUIRED). S'JI t t0 I J O PD CITY OF EVERETT BUS ESS LIC.#(REQUIRED): ,OC uIt 1 <br /> PRIMARY CONTACT: 0 OWNER A CONTRACTOR 0 OTHER(Please Specify) <br /> /" <br /> CONTACT� NAME: CONTACT PHONE: '2 j� LJ- \ -7(,f) <br /> ; <br /> -)Z r;koky`el1'1,, ,., I Ni ;�.,z.J kAr(,�V{V,PONTACT EMAIL: r 71�{ tit`- 'L • •`� <br /> AGREEMENT:T hereby certify 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 <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 /> _ _, .__ <br /> FEE <br /> ill? G-0,crp,---. <br /> PERMIT# <br /> P E (eO I , OW <br /> �, 01 fir;, <br /> Owner/Authorized Agen�Si nature Date (Revised 10/12/2015) <br />