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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> U <br /> PROJECT ADDRESS: Ai'[ZD W l Lr/(/ frVe -4 462 <br /> BUILDING AREA(if residential,new constructio remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED x-111 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: (9-f— (1j V(v,o <br /> 41'.7:117 <br /> a it pl OAlerd 0 <br /> CONTRACT PRICE OF WORK:$ I O vl 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: W VI 1D C'W W/14 t ' rot G(1-f- (i1(GU(if tS <br /> ( (ergVlt-0 W I r t(lg N not) <br /> t'ICAC'T INRQI ... ,' <br /> OWNER NAME: .N V`9 V l P V lul 6 C) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4-I2,o 003nye <br /> /� (J/-�� Q <br /> CITY F/ Y V r - J STATE V V' 7 ZIP 0[�/20 1 <br /> OWNER PHONE: OWNER EMAIL <br /> CONTRACTOR NAME: lin I(`(re. L l 60-0 GA l r"e'Y V (V c S , his• <br /> CONTRACTOR ADDRESS: STREET / }// (�m?4 /�a C/E <br /> r CITY /,-ti (1-b I /S STATV 4 z„./9 2✓/ <br /> CONTRACTOR PHONE:4Z-✓' tot 52-D CONTRACTOR EMAIL: /71679M1/1 i7JT , 7 6G/(. CO-114 <br /> CONTRACTOR LIC.#(REQUIRED): /N11dN _/5Z62-G1 '#( <br /> CITY OF EVERETT BUSINESS LIC. REQUIRED): 0/14//(0c <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR -MOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:.4.2 -7et' 3 2-6 <br /> I CONTACT EMAIL: G p(//144 1 ���jj//(//G( ((• Lj <br /> AGREEMENT..T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions ws 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-• and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> ' ', PERMIT# <br /> AIIMMIA . EvJ iBo- Oc <br /> Owner/Author zed Agent Signature V W Date (Revised 10/12/2015) <br />