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-ELECTRIC*L PERMIT A--J UliCATIION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> :PRA JECT SITE INF R ATION'-., - .. <br /> PROJECT ADDRESS: j ISS Loe---keC CCW <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: FR-DETACHED 0 SFR ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: -11-. l �1'— G //Z? e <br /> E ECTRICAL APPLICATION IN¢ORrIIATION. . <br /> CONTRACT PRICE OF WORK:$ /50 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C 2 - 00 8' <br /> DESCRIPTION OF WORK: <br /> Abl-tv 2" a ratit <br /> CONTACT;INFORMATION. -. <br /> OWNER NAME: 6CW ULin OSI'0 TENANT NAME(If Commercial),:"` <br /> OWNER MAILING ADDRESS STR€Er 6 � /L. <br /> � ?- ©G k e U e v )4 "e <br /> cj 1,6, ex GET • VO STATE ( ZIP <br /> OWNER PHONE: 2_0 t :- —2 9 6 OWNER EMAIL: je;&;0St.-C <br /> a7.-» c! f0,.: et400 ' Ctre7 <br /> CONTRACTOR NAME: d W/1/4/&<- <br /> CONTRACTOR ADDRESS: STREET ' <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:// ��/ CONTACT PHONE: X96 - W- 2-2( 6 / <br /> oLf r 7`/G b 751'h,/�G" CONTACT EMAIL: ctoSt til✓nN 0 GI L7.00 <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same ta'1fe true and correct. All provisions o 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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.20b WAC. <br /> City of Everett Official Use Only <br /> FEE it <br /> PERMIT## t i 9-1,0 9-Z /- � D �� ty), � <br /> Owner/Authorized Age Signature Date (Revised 10/12/2015) <br />