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14677 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> oRIGINAL <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: q V6-' 6 1 2.ABUILDING AREA(if residential, new construction, remodel, or addition) (psi/ler-4,a 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: $ E <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): �/ / (� <br /> DESCRPTION OF WORK: A Cir(fIt Jr' Z 7 fl k i Sc h��� ,p/Krip <br /> . MS All T <br /> CONTACT INFORMATION <br /> OWNER NAME: vi� -- r/ �v� (i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 30q , i(901,-.1 Q9-74 <br /> j/ //J/�/ <br /> CITY V evet STATE ZIP�J IiC/� <br /> OWNER PHONE:i0 ... V1 67 `6x OWNER EMAIL: %die LI Li` Vltd/( ,l!/i-i-7 <br /> CONTRACTOR NAME:'UP. Flail f, <br /> CONTRACTOR ADDRESS: STREET 1 6, /i (5_I 10 ./l <br /> CITY IAOW --riV y 0(C 1 STATE <br /> ZIP t I061,5 <br /> CONTRACTOR PHONE: "5 -711 r Z I-5 Ci CONTRACTOR EMAIL: I117r&�(// /7?�Cn Ar+. <br /> a) <br /> rr) <br /> CONTRACTOR LIC.#(REQUIRED): 51-1Crfe-31 14 A. <br /> CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C677ga <br /> PRIMARY CONTACT: 0 OWNER ttCONTRACTOR 0 OTHER(Please Specify) <br /> CO TACT NAME: f I CONTACT PHONE: 9p7 --7 7 /_� 7j Sq <br /> 0��nct I'�/�` c eQv CONTACT EMAIL: i ri"-G( fJjuto i�(At (,()),-4(;),--hl �� <br /> AGREEMENT:T herebycern that ave read examined this application and know the same to be true correct. Allprovisions of laws andordinancesv <br /> fY '(ry pp 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 /> *1 16 rit <br /> PERMIT# <br /> EB() - pOg <br /> i 1 .. l <br /> 0 Wer/7,wi 7.Ag t Signa ure Date (Revised 10/12/2015) <br />