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ELECTRICAL PERMIT A43LICATION <br /> ^ ,I4� CITY OF EVERETT PERMIT SERVICES <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: ,e/0 t/ .c ve r 5,- /3 f vcla <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF • <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 110 v>-C. <br /> - . ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 60 0, <br /> NUMBER OF DEVICES(if low voltage):, <br /> FIRE ALARM? 0 YES gr.,NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: IAJ 3...,‘,53...,‘,5 ['..e I c' Ke. w, -c._ cn'E / - <br /> 0-ecrL bJc l n (1, 71 - . <br /> CONTACT INFORMATION . <br /> OWNER NAME: Pa TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: swEEr , (G q /' e ./k-r-17. i l lc,/ <br /> CITY 4 -� !v, rr-c7STATE (/-4— ZIP (p V..2-0 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: PA Et<A4-1- 6- .e___7`-, /c N(i✓ <br /> CONTRACTOR ADDRESS: STREET 2-jp 7 0 " e7 $ <br /> CITY S r'l 0 (M t 5 STATE w4/ ZIP 7t... 9� <br /> CONTRACTOR PHONE: 41'i s-Kt/(,.j -(o 03 CONTRACTOR EMAIL: J 0 e7 (C .Q t,..,e 44.ele GY",c 4.t��-/�, Gcx� <br /> CONTRACTOR LIC.#(REQUIRED): �(�.p y-cA e..., 90'L o7— CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Ob �6 <br /> PRIMARY CONTACT: 0 OWNER ZONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ii 7_,5-- /c1/ __(0 0 <br /> e`dt 7 Cc>5-4(6 CONTACT EMAIL: <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 lam 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 /> 4lJO9 <br /> PERMIT# <br /> --= 147 E WV-10 <br /> Ow,= (Authorized Agent Signature Date (Revised 10/12/2015) <br />