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OLT ECTRICAL PERMIT AP (CATION <br /> ,/ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: (U 2.L Sra adw Duarte /i4- '8 Zv <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED llif SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Ikt 5I'dev <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2400. <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: tv1.1-ci(I Z klew COA 11gp I'c1' SphYed jPfr-vi« ec%rS <br /> ititJ‘av bas-e RQAIAiV -ftcaci-traM LI fttiws %IA 41,4,t <br /> CONTACT INFORMATION <br /> OWNER NAME: efu r7Ly C'xtrabrt'S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET,' /r'� DAX a i g <br /> Crry (0 u VC t/ STATE (/V - ZIP els 66 <br /> OWNER PHONE: 3(90 - 71 gZU(og OWNER EMAIL: <br /> CONTRACTOR NAME: Ut��pGt.C1� I-C�>�'%�'4 I , :erv%c-1 S 446 q p <br /> CONTRACTOR ADDRESS: STREET eft( /9 a t'e ,SG ire" tome`IJ n 7 <br /> CITY �!( ery STATE 4//4 ZIP g8GGp <br /> CONTRACTOR PHONE: 206- qq/- 64/27 CONTRACTOR EMAIL: andYe14/ lsl.Jxtc,-,4 -1'c4/4/4/.(°h� <br /> CONTRACTOR LIC.#(REQUIRED): I M P4ce5 g.3 a P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5 7 co a5 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:I W NAME: ales <br /> PHONE: 6 - 79/_ 6/d07 <br /> / tales CONTACT EMAIL: Andrew A/pifiec�.€/€6/,-/c4//W• Cott-1 <br /> AGREEMENT.:I 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 type <br /> 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 /> PERMIT# <br /> �`Z�1l8 E g0 191 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />