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• <br /> ILLECTIIC L PERMIT A I JCAT1ON <br /> "111111111,, CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 6)JECT SITE INFO MATI• - <br /> PROJECT ADDRESS: /D / /-1 /i1( U/ 1-44—, D <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 /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRiCE OF WORK:$ -5U 6 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • DESCRIPTION OF WORK: u--1 1 erg- a S ( s' Z /A/6 /-10(2,c4 • <br /> CO N TA.: .. .....'FORMATION O MA = <br /> OWNER NA : � \ ` CIO T NANT NAME(If Commercial): <br /> OWNER M LiNG ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ( / ': . 'L.( 7---fre( <br /> CONTRACTOR ADDRESS: STREET P, 6 , (30y, „nr( O <br /> CIN >// /V, v� U C7 0 STATE IA- ft 5 ,17z ZIP 910 J4 <br /> U l0 <br /> CONTRACTOR PHONE: �0(o 7 3 A91 CONTRACTOR EMAIL: <br /> CONTRACTOR LiC.#(REQUIRED): / l( n 4X 3 i/ tZ CITY OF EVERETT BUSINESS LIC.#(RQU1R 1, <br /> .:_. ,:�:,.. w,R-. <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> V ("f 1v 0 Al. )i f2 ic/ CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that l 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. <br /> City of Everett Official Use Only <br /> FEE <br /> • <br /> PERMIT# <br /> 9 Mrk-a JK H (&) 4zw3 -oO <br /> Ow r/Authorized Agent Signature Date (Revised 10112/2015) <br />