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/ , LL LECTRCAL PERMIT APPLICATION <br /> ,, ` CITY OF EVERETT PERMIT SERVICES <br /> t �.- y <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.govlpermits <br /> - P I,OJEdT:SITE C IF t I.M 4 II ilA'>::. ,;.`. - ; <br /> PROJECT ADDRESS: 5� 4111 GAWP Ati — . .ovir GO a , ' i at <br /> 'BUILDING AREA(if residential,new construction,remodel, or addition) -9Z�6:::7 SF . <br /> 'BUILDING TYPE FR-.DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> FUSE OF BUILDING: ' <br /> ELECTRICAL APPUUCATWN 11','F®R61ilATJON. <br /> CONTRACT PRICE OF WORK:$ / fj ' <br /> NUMBER OF DEVICES(if low voltages <br /> FIRE ALARM? D YES / NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORKi\ <br /> ,,f� �, � Ge1 j / e7 .15 t(2 <br /> e/PG= O ,G�� frS� /( / /-? ' i10'7 Z ---"G_ e e� <br /> (').._;-'107 r-e-.2..7) &- .---.-?‘• • , <br /> • <br /> OWNER NAME: DRa Vl T©l19 <br /> C TE NT NAME(If Commercial): /', <br /> OWNER MAILING ADDRESS: STREET %/�Zv 4/5; /,-- or Xi,,, ,, r/� G� Reze:''/ <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ]lm f'/�'h .. J/0/.;11 <br /> CONTRACTOR ADDRESS: STREET 7g'// "),',4"19" J3 /�, N <br /> CITY 9/f A -- STATE '4/ ZIP9032� <br /> CONTRACTOR PHONE: . •-Z�q(/..5, 3 CONTRACTOR EMAIL: /,, /-114,1 /t C re„-L-- <br /> CONTRACTOR LIC.#(R <br /> EQUIRED):°' 7i2J ? � -- ' , L// C.& CITY O EVERETT BUSINESS LIC.#(REQUIRED): ,41Wd <br /> PRIMARY CONTACWNER D CONTRACTOR vY`D OTHER(Please Specify) 11JW "~ n yryWW y� V j_v:�u.,,.-._F..., - ii <br /> CONTACT <br /> �. <br /> CONTACT NAME: CONTACTPHONE: — *41-5- �- 2)�©� / 04 <br /> /e -74::Y e.- CONTACT EMAIL: f <br /> AGREEMENT:T hereby cartify 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 lam authorized by the owner of this properly 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 0 <br /> 421-50 <br /> -....... <br /> PERMIT# <br /> „ 3 / h 1 GC: - OOLA <br /> allibt- <br /> \_ <br /> OwnerlAutIi-o 'ant Signature'- Date (Revised 10/12/2015) <br />