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4rEnw ELECTRICAL PERMIT APPLICATION <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 /> l.. . . . . ,f =y , f_ - m ]T NFO ATION" <br /> PROJECT ADDRESS: 0-`6b Lu-Lr �t2 <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> .-- 'EL* t$GA» APP ;104itION IfNFORMATION ' <br /> CONTRACT PRICE OF WORK: $ 100 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): r <br /> DESCRIPTION OF WORK: k- I _\ �..ait; <br /> �-6 -a-e. .-v Gi a <br /> I I,!li, - 'I �iN{FORMA ION <br /> OWNER NAME: S L SL.-hc)f Y1 oYl. Se.... TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 24-"RD t AMi2 _ 1J�\p /� <br /> CITY (sUCi� Qi�- STATE '�Vek. ZIP gG)Q 2O <br /> OWNER PHONE: / 3le ' to 19 - SI��J OWNER EMAIL: <br /> 1 /� <br /> CONTRACTOR NAME: �Q � U I�(y Q NM cc 61,U.--1-10n. <br /> c, <br /> CONTRACTOR ADDRESS: STREET /� ( PI] 1 o� I t (� <br /> CITY 1"lCL SVC-1�, /STATE I� ZIP ` 829-0 <br /> CONTRACTOR PHONE: 3Lpb•US-6j 00�' CONTRATOR EMAIL: lCrTh (Z {Fhe ISL ,Lovr <br /> CONTRACTOR LIC.#(REQUIRED): P1'\F--t`s 6.4-(catos �i CITY OF EVERETT BUSINESS L16.#(REQUIRED): t 3O✓g. <br /> PRIMARY CONTACT: 0 OWNER I.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3ipb , . q-IGj6Q <br /> 1JvvvA,� CONTACT EMAIL: j n--� Q 4.96, �A Y ir �Y`i 1 <br /> AGREEMENT*1 hereby certify that I have read and examined this application and know the same to be true and correc. All provision of laws and ordinances overning 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 /> I PERMIT# <br /> .� l <br /> � 1°1 cg E � � � D — ®7 ' <br /> Owner/A orized A ent Si nature Dae (Revised 9/23/2016) <br /> 9 9 <br />