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' !LECTRICAL PERMIT APPLICATION <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 I www.everettwa.gov/permits <br /> PROJECT ADDRESS: 016aoic , VIA 0I�0{( for / 2._ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED�,/ J�'SFR-ATTACHED 0 DUPLEX •MULTI-FAMILY-#OF UNITS: q 0 COMMERCIAL <br /> USE OF BUILDING: COM vlO 5 <br /> IdAtlit.:aye,,«sem «` .. • .r .. <br /> CONTRACT PRICE OF WORK: $ 10-00, <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: (I 7 ZU Ol VVI a It t/ & Cf' , e icSn ►0 v1 VVl <br /> t a Vt Vld wJ kTOOWl -� Gtu Vt oThOv1 <br /> OWNER NAME: S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I�OZ�/�.� SGjt'/{(/I C/ D� ' /Q, �}/'j <br /> CITY �VV V STATE I/V/ ZIP V (�(T-6 <br /> OWNER PHONE: 42...a2- • 0/70 OWNER EMAIL: N/A <br /> CONTRACTOR NAME: I VI 71 vu5e- �I,, <br /> CONTRACTOR ADDRESS: STREET //�l9SQD/\/�//7�*Gii D� J� / ,/fin} /� <br /> /' r CITY L✓t & yV,�eve�"6J STATE i'{/! ! ZIP qp��2,,✓y <br /> CONTRACTOR PHONE:�7 2' 7�0 2_U✓ CONTRACTOR EMAIL: f 1 e pe/Vi1 I i 1S(G e/11 c(l(' av1 ) <br /> CONTRACTOR LIC.#(REQUIRED): l N f0(,(E-S q92 ZRG7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ErCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: -4/2S 7620 32 <br /> !tel CONTACT EMAIL: ih TPA/VVI -y <br /> ( l S�(��/i/I�VIG(.I •C-8-74-1AGREEMENT.•I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of lis 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 /> 4111, City of Everett Official Use Only <br /> 411111V <br /> / PERMIT# <br /> Cb/3/�� E I c3.0(61-- <br /> Owne Authorized A!('nt Si s ature Date (Revised 9/23/2016) <br />