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ELECTRICAL 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 /> "yx /i , 0-‘7705044,40e,/,'/4iia,, ,,„moi/ / y <br /> PROJECT ADDRESS 57(9.1 /if'F-"p(C' IA/ (.(IIP 7- 5 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 1 FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF,UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: \� <br /> /// "�/ /// � � // mi�/ /i� �/��i/iii,5 � �q�z' <br /> O /�DOi/,':i/ +% 1 ;a ' G, 7/ /:%:!"), ,,ice € i,,->` <br /> � ��/ i%iiG%o/o � /�/'� /�%i�ii// <br /> CONTRACT PRICE OF WORK: <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: A--(L —t w ,4 <br /> OWNER NAME: &(,190.4.( ( ' •, Cr-ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S'7 2-( `4' , W at.,_,. (- 5 <br /> CITY 1-4N;/:I STATE (A/ri"_ ZIqgg9r j <br /> OWNER PHONE: `rta-c, 37ff- "2-`1 COZ OWNER EMAIL: <br /> CONTRACTOR NAME: 1ihv't'%?l--- l✓Zt cpLA.e_--- <br /> CONTRACTOR ADDRESS: STREET 7I: kr t gU f-" /4,...{._ NE <br /> CITY (IQ e (/V(064.-0Cr* STATE ZIP 1 ert1 i -- <br /> CONTRACTOR PHONE: 1-p-c--7- g-78.9 CONTRACTOR EMAIL: frk(kt (re c ..t - (zQa,r e . coif_- <br /> CONTRACTOR LIC.#(REQUIRED): 1.--(A t9 ...6-",.1-1(7.-Ce j1.4$5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED); /1 6 70 <br /> PRIMARY CONTACT: ❑OWNER I7CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: "S? 's5 � <br /> - 7� <br /> U`tIAN t*2 CONTACT EMAIL: OA,c(gf �1 °a-. eu <br /> AGREEMENT:I 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 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 perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> 4111° PERMIT <br /> fc0 � EI� <br /> o� l o'L �r , <br /> Own>T'uthorizent Signature Date (Revised 9/23/2016) <br />