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,dP* L ECTRICAL PERMIT ArPLICATION <br /> villi -,-.- 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 100 Z O0-kcs POI e <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> r ELECRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK $ Sa 3"' • <br /> NUMBER OF DEVICES(if low v liege):, <br /> FIRE ALARM? 0 YESIO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: PDO e 1'(...C7' Po2 F E.6?(-14 e6 <br /> • <br /> i., CONTACT INFORMATION. .. <br /> OWNER NAME: C-i I e- h <br /> s 2Lk-e.. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET // 1 OOZ- .00,--1C-C-S 4 U c— <br /> orn, C�vc rcti- STATE LA ZIP /Or-)V( <br /> OWNER PHONE:(Z 6 1—" 9 ql a OWNER EMAIL: <br /> CONTRACTOR NAME: .-JD6(Z P t ,C.`T EL L <br /> CONTRACTOR ADDRESS: STREET 12-?C`/ LRm.--1T'6Q Dv_ <br /> CITY gj\AA,�JC.^erS STATE ZIP 9: <br /> CONTRACTOR PHONE: J "3I q—c..12 Z CONTRACTOR EMAIL(((-�LUA? Gf2 P —C. e.,. M-AS . Cor- <br /> CONTRACTOR LIC.#(REQUIRED):V iDEC Sci six_ CITY OF EVERETT BUSINESS LIC.#(REQUIRE r:O� 0(-'7 I t, <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:'TZTL CONTACT PHONE/ `36 v) 3 N -la 122 <br /> - V(}---)De ,p 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 I am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC <br /> City of Everett Official Use Only <br /> FEE <br /> , r-4 S ,_—___ <br /> rPERMIT# <br /> .-/i:4/. <br /> 4/ t. E a3s -e_D� <br /> Owner/A ..rized Agent Signature Date (Revised 90/92/2095) <br />