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ELECTRIC,'• L PE-!iIT APPLICATION <br /> /4111" <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 SITE INFORMATION <br /> PROJECT ADDRESS 1 '' E.v fo`rs wQ,es.—. <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED Irl DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: c\:0 SSS. Ok-4C-' .� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$(.71rj-1 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: q, . c <br /> ,0clC,2r^�I Vi)o\C' 4C ' ,O4NrForcgv\Tc:\ • <br /> CONTACT INFORMATION ;. <br /> • <br /> ^ ,n <br /> OWNER NAME: SQ0('�N�, s VIA (SO, TENANT NAME(If Commercial): 524,0QNC PtA%o V las S <br /> OWNER MAILING ADDRESS: STREET 13(5 W G,(I s`tt'0 rt <br /> i ZIP���, <br /> cin, -piSTATE , <br /> OWNER PHONE: -- a :714 I (OWNER EMAIL: , _ , . . :.. ... .,. <br /> CONTRACTOR NAME: ,„..;N FA`DG` ettc(f>1 Cl) <br /> CONTRACTOR ADDRESS: STREET?C , jt X CA(-4 0 ((�� ( <br /> cm( gea)QS-�2II STATE ZIP 99 O(v <br /> CONTRACTOR PHONE: 1 j 95 339 '-cgs( (CONTRACTOR EMAIL: CaIn, 'CGSS) l.b,v+C,pst . C\41 <br /> CONTRACTOR LIC.#(REQUIRED) (ZAS $ .X1-"1 QO (CITY OF EVERETT BUSINESS LIC.#(REQUIRED):OJ <br /> .0 r(0 <br /> PRIMARY CONTACT: 0 OWNER AsiCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lk _ 15 -- V V to <br /> anrt ( CASS\0 CONTACT EMAIL: <br /> AGREEMENT.T hereby certify that t 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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> FEE <br /> ' # \la •51),/ <br /> C ;Z\ O 2 <br /> Owner/Authorized A ent Signature PERMIT# <br /> EW 1(61bDate (Revised 10/12/2015) <br />