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LLECTRICAL PERMIT AIM LICATION <br /> #111111°Posi <br /> ..440 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 j www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: )1 Oo Mewl, Creck_ea'esk-7 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED 0 SFR-ATTACHED CI DUPLEX 0 MULTI-FAMILY-#OF UNITS: R'COMMERCIAL <br /> USE OF BUILDING: <br /> EL CTRI•AL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: I <br /> I Zoo°t 0 <br /> NUMBER OF DEVICES (if low vo tage): <br /> FIRE ALARM? EI YES 14 NO <br /> ASSOCIATED BUILDING PERMI . (if applic., e): <br /> DESCRIPTION OF WORK: // L( ci-f-cfrilAT- kn_ S7y), d— C ,$)-4,4i t.:5 Al <br /> CONTACT INFORMATION <br /> . <br /> i c <br /> OWNER NAME: Iiii//. Jr, /PC.1-Yrk..., TENANT NAME(If Commercial): S411-e_ <br /> OWNER MAILING ADDRESS/ STREET PO 0 ni-e/rY)77 (fr--rti. rcr/i sivr <br /> CITY If veil t -- STATEkr,j4 ZIP 980,? <br /> OWNER PHONE: yty-Yo-yoy3z., OWNER EMAIL: <br /> , „ .. .. <br /> CONTRACTOR NAME: IA/f bit ik Ofirx` <br /> CONTRACTOR ADDRESS: STREET i/ 00 niffrYi I/ ( kW...A_ AA—A'447 <br /> CITY Ellel,09- STATE 14.04 - ZIP 9 <br /> CONTRACTOR PHONE: 26)--S52-Fi PI CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): VeirnitLitii Nip.- CITY OF EVERETT BUSINESS LIC.#(REQUI-'D):0 2l558 <br /> PRIMARY CONTACT: El OWNER i<CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAMS CONTACT PHONE: z,b, 0----z_. si rt./ <br /> C #-0- <br /> /71010 ) CONTACT EMAIL: S C.4 /TN" tiriftyik-) c,` h AGREEMENT:T hereby 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 <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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> O2 - 0C31 <br /> PERMIT# <br /> ch-ci iijeE <br /> IlYir? <br /> Owner/ orized Agent Signature (Revised 10/12/2015) <br />