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,LECTRICAL PERMIT II I LICATION <br /> oelliv,"!:--,....._A . CITY OF EVERETT PERMI 'VICES <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: 211-1 .A1vec s o A. (Moak . G lit J'r Tr WA . 98 2O 1 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) CCCS;,Pee1.4 al SF <br /> BUILDING TYPE:'SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 1-4 0 Ai e_ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 7 keel jt&t OW Ajuhr I S 00 4-.LL .tO-( L. <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? j'YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C 16O -.O2O {� <br /> DESCRIPTION OF WORK: 1tlf CA 1-G1/4.)0 S dvl << &AC0®Mc Nde ©AP_ 30e.afo . <br /> Pic O,A d` -r/t- e_k g‘'Cwt d- k Coo" 0 One- <br /> CONTACT•INFORMATION <br /> OWNER NAME: Se(kA Rol%ok TENANT( NAME-tl (If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.1£. At�/e(S� (M j0k /, <br /> ccivE 'e reit STATE WA ZIPCig 20 <br /> OWNER PHONE: Z-I 2CI L I .0et 5-._ ..a ...OWNER EMAIL: W 1 t cAb©(G S k 6,v 1LC,v ._ <br /> CONTRACTOR NAME: ®LJ&U r <br /> CONTRACTOR ADDRESS: STREET5(�/�/� /^p <br /> CITY 0_A .t ac v��c)c) S� ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> n <br /> PRIMARY CONTACT: �OWNERa�✓ V - <br /> CONTRACTOR 1]`OTHER(PleaseSpecify) <br /> w,....���-�•M�'N��`_.:...�..,...w,d -�._,.,�.�,.,,.�,��.y,..�.:M.�.�.�,.,�..,,,a,�, <br /> CONTACT NAME: CONTACT PHONE: ( ( Z�^ 9(-.i( - 01)15- COAA <br /> 5c?k� �DC� CONTACT EMAIL: WI'/\A 100kL��; _ Cc I . \ <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 /> City of Everett Official Use Only <br /> FEE <br /> bOo-2- <br /> PERMIT <br /> # <br /> A.., ----f--221Ola . 7 <br /> 2'7 i l6 E I (oO Z-�o, <br /> Owner/Authorized Agent Signature ate (Revised 90/92/2095) <br />