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.. PICC CTRICAL PERMIT! PPUCATIO <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT ADDRESS: rt-3 0 'f Y v'e_rr c`1 r- ee— P uJ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF ' <br /> • <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: 5 •tc.e.fd <br /> Acir <br /> ELECTRICAL APPLICATION iNFQR 'ATION :... .. :.. <br /> CONTRACT PRiCE OF WORK:$ 7� <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES Ii NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): p <br /> DESCRIPTION OF WORK: Sic.-C� 2_3()-ti3 CFrt t� 4.. `h Yom-A <br /> • <br /> OWNER NAME: ley 'J <br /> / TENANT NAME(If Commercial): rift - 4 S <br /> OWNER MAILING ADDRESS: STREET /67 3 JK <br /> O.�[ 44/(,y'J(/^ri l �� ej <br /> Crr( I jr �" �/ STATE .` ZIP <br /> OWNER PHONE: /+- OWNER EMAiL: <br /> CONTRACTOR NAME: ���e -e..T� Z(�,.0. . 5 vYZ`e.j <br /> CONTRACTOR ADDRESS: STREET Po 2.40"51 <br /> CITY 6ra4L STATE LA-T"� ZIP s Z <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): y (j/l CIT t g 1 1 .#(R D): 9y( <br /> Y OF EVERETT BUSINESS LIC EQUIRE <br /> .. .. .Y_....,_-.�.,....,,x.�.....,...�..�._r,.�.,,. mw,..., <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: cfz5:.3VC 7327 <br /> CONTACT EMAIL: <br /> 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 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 WAG <br /> City of Everett Official Use Only <br /> FEE4 P <br /> PERMIT# <br /> F 1—\ <br /> Owner/Authorized Agent Signature Date (Revised 90/9212095) <br />