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ILECTRICAL 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 vwvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: -3 O 1 c o I 1 G.,.,e, 2 `Gcl/4; 9 , 01 <br /> BUILDING AREA(if residential,new construction, remod4I,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX atC' 1-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: /�M e <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ --- 0 - <br /> r <br /> NUMBER OF DEVICES(if low voltage):. r,,,--'T ,//-1 <br /> FIRE ALARM? ❑YES LTJ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: eArrtyv9 cam/ rrj/ 4714/7 1-4 6,/,.r,-- . <br /> of/� OUf is ;-%C.:7/2. a (.clee• 1�'� c fS rhA./ it/C°7..0 14./e//.- A/ <br /> "✓ j 44/ / C',�t-74c� ,%� i'cv• cZ.--e "5". ' /� r J a is ` <br /> IV ( yt�e',S °/71747;09-ri-J �90/4,--,- -„-7 ------6,d' JY i <br /> 1 <br /> • <br /> -- CONTACT INFORMATION. <br /> OWNER NAME: L_4I ,•At CI p k' TENANT NAME(If Commercial): <br /> ri►, <br /> OWNER MAILING ARESS: STREET <br /> l 0, X7/0 <br /> CITY C v( e - STATE Vv ZIP rO7. <br /> OWNER PHONE: 4ç-J .7 -<-�"�{�.O 'OWNER EMAIL: <br /> CONTRACTOR NAME: �'l I"b M('e:Uhl."-1 <br /> CONTRACTOR ADDRESS: STREET 99 7 -7- ,2 Z pep jp <br /> CITY / el ir/774- "Ci `"STATE U/4 ZIP 9 FP 7.5- <br /> CONTRACTOR <br /> SCONTRACTOR PHONE: ,36,0-,-,,,?0,4.-0 7c/'7 'CONTRACTOR EMAIL: -rrs 47,l f 1 /,3[ r c„,,,,f,,. <br /> CONTRACTOR LIC.#(REQUIRED): 'CITY OF EVERETT BUSINESS LIC.#(REQUIRED: <br /> PRIMARY CONTACT:�a ..M <br /> 0 OWNER CONTRACTOR 0 OTHER(Please Specify) ~I...N.. "'Yr4M"vV Jw4 <br /> CONTACT NAME: CONTACT PHONE:3W`gc2-Q) 7c7 ri <br /> . CONTACT EMAIL: sM/ / # <br /> AGREEMENT.T hereby certify that!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 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 /> FEE <br /> PERMIT# <br /> iti., eq/05-(20/7 ' -' o25 <br /> Owner//.uthorized Agent Signature Ddte (Revised 10/12/2015) <br /> 1 \ <br />