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ELECTRIC IL PE 1'\MIT APPLICATION <br /> • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 f FAX 425-257-8857 1 (E)everetteps@everettwa.gov l www.everettwa.govlpermits <br /> PROJECT ADDRESS: "i ,:.,..•` t' S jj 0i 1 <br /> BUILDING AREA(if residential,new construction,remodel,or addittdh) SF <br /> BUILDING TYPE: IA SFR-DETACHED ❑SFR ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: NI COMMERCIAL <br /> 2E aF BUILDING: pe C, EveF-r ' <br /> <::,. '• � E .I�', RY �Q>l.;l#�•�'1 �/{�j.A1I'��.. ._��.,..�Oit1{HA,T901� :�. <br /> : .. ....._ .. .t .. ....::..• .v...J.n..aSA..A b4�-:niYa•:.Y.I.aS.i•.. i..y.:. .i"a ...r-l-)�..- ..�t'Vi.... J.n.. y:- t,,l•.41.. _...L.i`iii'.'.`e....._.,'l<}iz5'.:4t�...�ri.r:li..:..i 11.x... <br /> CONTRACT PRICE OF WORK:$ �.j ) 006 <br /> NUMBER OF DEVICES(if low voltage); <br /> FIRE ALARM? 0 YES g NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable):`` ` - <br /> DESCRIPTION OF WORK: Z x: ''3 k - ,..1(°<�y";, r� r - � f"' {y ' <br /> '_y �,. _r `Y�.�.. ��'✓�lj ��'"`"� .,t !} fir+ �a�`(.l`"�>$,.�..��;q. .�.,� l t t�'�'"���, <br /> �'' .i k' 1.ow '-,°a ti+` r3't�k't/.-'} t• i i' 3:�,✓ 'moi M1. W.,e?��+Oc ff �„! <br /> w�....€....: � 1 tis 4'.11 �! ,,,:i...Y, f <br /> • <br /> • <br /> Y _>. COMTACT'lNQRMATION _ , <br /> OWNER NAME: TENANT NAME(If Commercial): :M.)6 <br /> OWNER MAILING ADDRESS: swear pa $ox 3707 <br /> CITY $e-A'T TLE STATE iAi4 zr 93/2!/.2207 <br /> OWNER PHONE: j OWNER EMAIL: <br /> /1 <br /> CONTRACTOR NAME: l e/V L- 9P5ne JL!7.76), -) W V <br /> CONTRACTOR ADDRESS: STREET Pp $DSC 41, <br /> cm, mfjlT <br /> g�I[G (� srA ,- I M- ze9gza4 <br /> CONTRACTOR PHONE:426-214-69`/ CONTRACTOR EMAIL: k4-ei. 1{4/nM E'^1ee)k/ 1WJ1 r, L'O/Y) <br /> CONTRACTOR LIC.1#{REQUIRED): 6EA/8.edC,3 QZ CITY OF EVERETT BUSINESS LIC.#{REQUIRED):040515.M <br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 204)-736-6544, <br /> . DENNIS 64dW CONTACTEMAIL: DEW/is, 1'1Ew/iT. £oM <br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances governing this <br /> type of work wilt 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/em 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 ROW and 296.200 WAC <br /> City of Everett Official Use Only <br /> FEE <br /> 1 e' <br /> PERM[ # <br /> E• <br /> Owner/Au orized Agen Signature Date (Revised 10/12/2015) <br />