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"NW_ tiLECTRICAL PERMIT ALIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: !j�l2 to.AA Qc 'T Et/efe , tG� <br /> BUILDING AREA(if residential,new construction, remodel,or addition) [_(510 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION- <br /> "CONTRACT PRICE OF WORK:$ /1/(5$77 0-O >x ,KIX-41:2 <br /> NUMBER OF DEVICES(if low voltage):, <br /> FIRE ALARM? 0 YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: C'0 'y-e 411-/ / � ( X2 6 / <br /> CONTACT INFORMATION <br /> T OWNER NAME: , /F( 7 O✓mac f 6----TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ///Z z 7 2� P f7R 5 <br /> CrrY �v T/(��i7 STATE �G� ZIP ?g Z <br /> OWNER PHONE:4/2-5 ,...,6 d ' /. b OWNER EMAIL: <br /> A CONTRACTOR NAME: /,�!�-.�F•� - OI�t' ezEt .7 t <br /> CONTRACTOR ADDRESS: STREET /3 6//( C)CCI p(7/774t-/. ,.A✓e..- < / <br /> CITY A ccAl �SSTTATE /( ZIP � / C 2 <br /> CONTRACTOR PHONE:2c). - 2( CONTRACTOR EMAIL: cep /-/.40,4_,/, c-�• '6 C C AO`b <br /> CONTRACTOR LIC.#REQUI ED r. 3 _ <br /> ............................................... - <br /> PRIMARY CONTACT: VOWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONT CT NAME: CONTACT PHONE: e(a 2 (r5-7c/ <br /> . CONTACT EMAIL: 4 (� 2 6`6 �'a/✓C 6, <br /> AGREEMENT/hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordi 9�verning 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 /> p A <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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> / PERMIT# <br /> E ItO)- 162., <br /> Owner/Authori.ed - ire ate (Revised 90/92/2095) <br />