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LLECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 477 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: BOO ?4U!-•C A LvCr44 a* le zo <br /> BUILDING AREA(if residential, new construction,remodel,or addition) 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:$ r7.. )Q.'�✓ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> D RIPTION OF WORK: (-O. / prKt-Jeri rczznw/ G4311CAttl- - CA'su' <br /> «mak SFr t platA r-. t ?air res . <br /> taut>;ot t- CC IArc.A.s R.4, a e .. C-4. P>e"'' <br /> CONTACT INFORMATION <br /> OWNER NAME: (a-00;CXC"C( 1,t,C j pyt L, f ,4 t1 Q*C NANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET r <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Vt.to E lex}r� - <br /> CONTRACTOR ADDRESS: STREET ?0 ff �va',G 8 04(o q" /y�y�� <br /> CITY �S.a.44 t �- STATE ZIP 'V tot?) <br /> CONTRACTOR PHONE:204—436—.5-2•00 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): VE GA 6.C.IZ 42 MV CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(�SMS <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) K M <br /> CONTACT NAME: CONTACT PHONE: ,� •• �p ((�• � ,z06-es--0-9,30),-Se-155A 934004Wq� CONTACT EMAIL: c -SO'l.cYJInOf.Ul1.4 <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 specked 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 Q r <br /> PERMIT# <br /> rc �� ��P E ( (p(( tS 5 <br /> 0 ner/Authorize gen Signature D to (Revised 10/12/2015) <br />