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Jan 23 18 02:29p Bob Jack 15096746777 p.2 <br /> '. ELECTRICAL CAL PER OT APPUC r'1(1*i4 <br /> ..,*01 _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 ( (E)everetteps@everettwa.gov J www.everettwa.govlpertnits <br /> -• - - :0004TWr.P91M WO)1iN0:114:11-4 - - . . . - .. •:':•-•' <br /> - <br /> PROJECT ADDRESS: ' ri awl ui <br /> BUILDING AREA(irf residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: L OMMERCIAL <br /> UOF RWDIN <br /> SE LG: /. <br /> . . JeLIECTR C1 ;APP>l:uCJa i® I iNFORINIATION <br /> CONTRACT PRICE OF WORK$ /'7_15 0 <br /> NUMBER OF DEVICES(if low voltage):• (.,,o <br /> FIRE ALARM? D YES 7419 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I <br /> DESCRIPTION OF WO K: ....ii.....ii ( _A., i 'a _ 44 1..,,• <br /> pON, A, t.s -e/k):c P r--S <br /> , <br /> OTITi4G'i';IIyNFORMATION_: .. . <br /> OWNER NAME: 'e j4 G TENANT NAME(If Commercial): -� �' t C�-� <br /> OWNER MAILING ADDRESS: smear i <br /> cm' STATE <br /> J ZIP <br /> OWNER PHONE: fOWt4ER EMAIL: <br /> CONTRACTOR NAME: IAA 6 - �r' U � : .., . .r <br /> CONTRACTOR ADDRESS: maser. 4 •) kic , 0.--4ka el, ' <br /> CITY X 1 44+ STATE r 2JP t Z} <br /> CONTRACTOR PHONE$2_ l -‘/6 7,2,5-q C !' 7 CONTRACTOR EMAIL: �� <br /> CONTRACTOR LIC.##REQUIRED):....y . �_ r uµT `.....�!CITY OF EVERETT E�USINESS LIC.CREQUIRED): SYc f <br /> :PRIMARY CONTACT: L]OWNER Y \F CONTRACTOR 0 OTHER(Please Specify) <br /> • <br /> CONTACT NAME'• 'A� <br /> t CONTACT PHONE: �p / �'1. C�.'� <br /> • W ► �, _ CONTACT EMAIL: •?j eEsk lAsc pti. .e. <br /> AGREEMENT:Thereby certrfy that I have read and examined this appticalien andJmowthe same to be true and correct. Ailprovistons of laws and ordinances governing this <br /> type of work will be completed whe,'herspecc•5ed herein cr not. The granting of pem-ut doos not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regutating construction or the performanco of const-action, That 1 am authorized by the owner ofthis property to perform the work for which appiication is made and I <br /> comply with the State Contractors law 10.27 RCWend 296.200 WIC <br /> • <br /> City of Everett Official Use Only • <br /> FE1EI <br /> 0 <br /> PERMIT# <br /> Orme •uthor' .d Agent e Date (Revised 10/1212015) <br />