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/11111Pd <br /> !LECTRICAL PERMIT AiAu LIGATION <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 /> PROJECT SITE INFORMATION: <br /> PROJECT ADDRESS: 3 i 4=91.6k,i ANA ., <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE:l -SFR-DETACHED ❑SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Eai iI2A/e. off/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ \ 7 oo0t <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES SIO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: k.(� /Rer Q - V�\�,,\,, 1k C� ,\^� '��— <br /> _.. <br /> U <br /> CONTACT INFORMATION <br /> OWNER NAME: ..�,, I ea,t4 0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES : STREET (o,,2E' aa i <br /> CnY V edU STATE t4_/ ZIP 9 3 7 F2... <br /> OWNER PHONE: -I`c ,rj -3 ,"SS OWNER EMAIL: - . . <br /> CONTRACTOR NAME: 5� I tP14r , T rx. a <br /> CONTRACTOR ADDRESS: sTRE//er` l OW C a,V c .. <br /> CITY C r\es --"K:5 STATE ZIP l 3 <br /> CONTRACTOR PHONE:3(0 3$7 1 1.S 4, CONTRACTOR EMAIL:'.�� A-1 My-6,2g <br /> /_ >lll q /t SK <br /> �-�, �Ldz,Y�2 (/D <br /> CONTRACTOR LIC;#(REQUIRED} , r/ C/ n v`CITY OF EVERETT BUSINESS LIC.CREQUIRED) 4e 73 <br /> 11 <br /> PRIMARY CONTACT: ❑OWNER id CONTRACTOR 0 OTHER(Please Specify) <br /> CONTA T NAME: CONTACT PHONE: 3 60 c? _6 7 �7� J /,,,,y� <br /> �a►,�_ CONTACT EMAIL: 5w i,� r,t c e“,.. ,I c2 fl <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and All provisions of laws and ordinances veining 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 /> ' fifivo '�f <br /> / PERMIT# <br /> die <br /> AitiMaliib. 4:: E n.03, 16t4 <br /> Owner/Authori -d Age IVIr reN ate (Revised 10/12/2015) <br />