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ECTRI ,A,L PERMIT - , LIGATION
<br /> - - - CITY OF EVERETT PERMIT = VICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov i www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: l GO Ct .. at A�V... `l"..._ C jei' ±k .1\ t 4'—60 k,
<br /> BUILDING AREA(if residential,new construction, remodel,or addition) / 6°® SF
<br /> BUILDING TYPE:<SFR-DETACHED SFR ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: 2,e 5,1'eA L C t
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ �56 .
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES , fNO
<br /> ASSOCIATED BUILDING PERMIT (if applicable):W�
<br /> DESCRIPTION OF WORK: ('`-✓\ ¶ \Lto`�'M. .'`e aotitiAl_ k-'-9O y\e-✓ G.'.f m l'- -s Cor t'e(5,.
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<br /> CONTACT:INFORMATION 7. -
<br /> OWNER NAME: IN A^a l,Zt Tt l A vtoCk TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY � STATE ( ZIP
<br /> OWNER PHONE: _ `02.5..46.u?-....22...-. OWNER EMAIL
<br /> . . ,/.. »_:. . ... : Lack .kkot.Aoc , ® cv `1,. CvvA- �.,_..... _._
<br /> CONTRACTOR NAME: 6,...),\Cv. (Cal.(' Q
<br /> CONTRACTOR ADDRESS: STREET C 12`,,�6 G /2 1 Vt V(_ k)Q. ` -' q(62-5`75
<br /> r�7 CITY i c(..A 5 e` vt S STATE O ( ZIP
<br /> CONTRACTOR PHONE: -L Z5-�� "l-55 k 1 q CONTRACTOR EMAIL: S CNkC�()yvl 5 .VChe,.2CC.'I.0.Lo✓�
<br /> CONTRACTOR LIC.#(REQUIRED): 50 XC G L t LO?K CITY OF EVERETT BUSI'ESS LIC.#(REQUIRED): 0 SZ 557
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<br /> PRIMARY CONTACT: 1:1 OWNER AKONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAMEj{:' CONTACT PHONE: q2.5- 3j5©—q14,42,61 ii
<br /> `6P"'" G(.,Gig 5 CONTACT EMAIL: �0.n 0 iryttA 5 `.oLV(�'le\- eCC r c tO✓7
<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!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 /> t 0 0 ,
<br /> PERMIT#
<br /> IP --'41.1.' E tik) [
<br /> li 0 3-0O3
<br /> efillAgent Signature DateOwnerlA" • e• (Revised 10/12/2015)
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