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ilt <br /> ECTRICAL PERMIT APHCATION <br /> I�►� �- 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 l www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 51 t F.o-Crrk— - t.A au W(A,y S fie- I f\ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 41IcCOMMERCIAL <br /> USE OF BUILDING: S\-)i).' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 300 <br /> NUMBER OF DEVICES(if low voltage): 2. <br /> FIRE ALARM? 0 YES RrNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: \c III J (J t(\JJ,0 CA\(li^1Yl.e, , WEil S i lif1.-.S <br /> CONTACT INFORMATION <br /> OWNER NAME: 2,(Y\O71°,0-elopm tAryi +'ap LLL?ENANT NAME(If Commercial): S pt'^;,r i' <br /> OWNER MAILING ADDRESS: STREET tri(CI 252nd 9jz, <br /> ( N <br /> CITY Ri nil J STATE WA- ZIP els-0 5 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'vt-f (-P,( S 4n, Can p aiN y <br /> CONTRACTOR ADDRESS: STREET 2.1.12,01 /f 9/ 5 - <br /> CITY kit® J 4 \/ 'd�,n of) / STATE `P ' ZIP a,-Lf <br /> 3 <br /> CONTRACTOR PHONE: )CE)�'(,{� 12j)-S 1I CONTRACTOR EMAIL: Ste.Cavil C P r q-eirs qyr_ <br /> CONTRACTOR LIC.#(REQUIRED):tok'\ag,5(� ��ZL CITY OF EVERETT BUSINESS LIC.#(REQUIRED): `7 1 0 <br /> PRIMARY CONTACT: 0 OWNER .®'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(O- 2.9- 13 a 5 <br /> S ( r"C 1 E IA (\1Cc(.1.� CONTACT EMAIL:sv_ec, e ✓s1 e:7d1 - ( ✓W1 <br /> AGREEMENT:t 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 /> 111 7 /17 E <br /> Owner/Authorized Agent Signature ate (Revised 9/23/2016) <br />