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"1111111',,,, /—,A ELECTRICAL PERMIT APPLICATION <br /> , CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteeps ?a eve ttwagov I www.everettwa.gov/perrnits <br /> r PROJECT S1TE'INEOI( boli <br /> PROJECT ADDRESS: 1 c4 t- 0 ales 4 v°c <br /> BUILDING AREA(if reg entiat,new construction,remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR ATTACHED -0 DUPLEX 0 MULTI-FIWIILY-It OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: d,,,fi t V t <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 500' <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: z 0,,,4,1,i-- 4.0, ° r - r'# 6 <br /> CONTACT INFORNMATION <br /> OWNER NAME: l ci r`ck t A. -°- c Ciirc�t. NAME(#Commercial}: <br /> OWNER MAILING ADDRESS: STREET 1lc, 3 60,63.; +J Pruc J <br /> STATE J, ZIP 1 <br /> CIT! '�1`ta1''4•." '�. , <br /> OWNER PHONE: OWNER EMAIL: <br /> . . <br /> CONTRACTOR NAME: 1)t CJ tJ (t, 'bans liItt44`•'L-c Y „"° <br /> CONTRACTOR ADDRESS: sTREET i i3 c ,.}q� <br /> CITY A x r,,,,,Ii i 1 STATE 2P <br /> CONTRACTOR PHONE:43S-1 j"' let t ,, CONTRACTOR EMAIL: I t 'j 2ylv i yr irtrea.i . = t:.en <br /> CONTRACTOR LII,*{REQUIRED):1)tCk.14-S . 1 3 1k.. .. ,.jai),OF EVEREI T BUSINESS LIC REQuIRED): Oteri.041.0 <br /> PRIMARY CONTACT: D OWNER CONTRACTOR ISI OTHER(Meese Specify) <br /> CONTACT NAME: CONTACT PHONE; <br /> 0-eiik A£-Cor d 4.1 t YL2C.>' . CONTACT EMAIL: P13 e y"1i^t i . C <br /> AGREEMENT::t"hereby certify that f:have read and examined this application and know the same to be true and erect Alt ptwsione oflaws and ordinances governing this type <br /> of work mil be completed whether specified herein or not. The granting of a permit does not presume to give authorlyto violate or cancel the provisions ofany otherstate or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner ofthis property to perforin the souk for which application is made and! <br /> comply with the State Contractors Law 18.27 RCWand 296.200 WAC. <br /> City of Everett Official Use Only <br /> i C' ( t ' ? ,. 6" 11.)112 <br /> PERMIT# <br /> orlAutho =rr>•;Signature Date (Revised 9/2312016} <br />