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•LECTRICAL PERMIT ALICATION <br /> /111.4%.F". 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 /> r I � <br /> I'IROJEC'Ir`:SIITE I NFORIIYI 4'T ilii <br /> 0BUILPROJECT ADDRESS: SI OS- 6 Ve, re��n kikkAAti )0S- <br /> BUILDING <br /> DING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED <br /> c 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: CO IAAv �'e<( c4SttJ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ b SC) <br /> NUMBER OF DEVICES(if low voltage): a <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> 5W� L ED <br /> CONTACT``INFORMATION <br /> OWNER NAME: A t.'‘ civ. C„hn iC TENANT NAME(If Commercial): 6 CI fr (Qv. <br /> OWNER MAILING ADDRESS: STREET`"---7 EVe.r5 r•e,c-n \Aic.y $-k 181 k <br /> q, CRY I STATE�j� ZIP 9,8' 3 <br /> OWNER PHONE:I-i)c-a t`� - Ill` OWNER EMAIL: <br /> CONTRACTOR NAME: 0 6u �j U S AAA <br /> CONTRACTOR ADDRESS: sTREEr l�l 2 Cr /IC( j( .()( <br /> CRY l.Ai WA-- be® STATE tQ's ZIP Tg o t-f-- <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: R t('V`y ,r.*, <br /> CONTRACTOR LIC.#(REQUIRED)14((k4#t)((1b CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0 a co?„ct <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR jlOTHER(Please Specify) <br /> CONT CT NAME: CONTACT PHONE: 4-Ds �3s 7s- `'`I '? 3 <br /> CONTACT EMAIL: <br /> AGREEMENT:Ilhereby 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 lam 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 /> H. <br /> / E - S 29- <br /> ner/Authorizent Signature Date (Revised 9/23/2016) <br />