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ELECT C A PERMIT APPLICATION <br /> -.-,- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 J (E)everetteps@everettwa_gov J www.everettwa.govlpermits <br /> PROJEC9NF <br /> T S TE a 44.000;10W-: <br /> a <br /> PROJECT ADDRESS: .69 '/ Q r) 016 T Rd / <br /> BUILDING AREA(if residential,new construction,remodel,or addition) )4 GU SF <br /> BUILDING TYPE .I frSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> N <br /> USE OF BUILDIG✓✓✓:��! <br /> ELECTRICAL.APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �I ) '// <br /> • DESCRIPTION OF WORK: (,.n 34 A j 21O Y G� p� �a GJ ct 4: #- A _4I^ <br /> • NT INFORMATION <br /> . .: .. CO ACT; <br /> OWNER NAME: Sea--)-f L/l R./ 1 C Ir- • TENANT NAME(If <br /> Commercial): <br /> OWNER MAILING ADDRESS: STREET 3- 01/ .4 kr; !fir Y'o <br /> CfrY F ve_.4 1! STATEfri14 ZIP 5",6'2.49&OWNER PHONE: 266. .3,s-4. 07 3C OWNER EMAIL: SGBaTC✓�aKdle -0 _ hA' • Co 17, <br /> CONTRACTOR NAME: 664.)'Le r- <br /> ADDRESS: STREET - <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: gOWNER 0 CONTRACTOR ID OTHER(Please Specify) <br /> CONTACT NAME: f r CONTACT PHONE: <br /> �AS Ca it-dlt (�i CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that!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 l am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE ---- -- — <br /> 7 5 <br /> PERMIT# <br /> o c J1 .16 > �'o — i '15 <br /> Ow • Authorized Agent Signature Date I� (Revised 90/92/2095) <br />