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4"7 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ORIGINAL <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PR CT SITE INFhORMATION: i ; . <br /> PROJECT ADDRESS: q,ICI 010161 RUCK, <br /> BUILDING AREA(if residential,new construction, remodel,or addition) r.15jdeid is SF <br /> BUILDING TYPE: *FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> 'F f1gab Y' ELECTRICALAP�PLICATION INFORMATION�;pry 3,! w ��F <br /> CONTRACT PRICE OF WORK:$ 04 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1 j 1(,Q aril ILI rd Poit/a(tf C`V y-e er4- ` <br /> -,, --.,,..,: , , ,,,,,,,- '. . CONTACT INFORMATION <br /> OWNER NAME: elK' �� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDfiESS: STREET q`q era /e. <br /> CITY EVVr€f4 STATE (A/4 <br /> ZIP gewi <br /> OWNER PHONE: gib 39q- 5-74q0 OWNER EMAIL: — <br /> CONTRACTOR NAME: 13 t u fro <br /> CONTRACTOR ADDRESS: STREET I`i�,p TjIa 447 (5 F c if J * I <br /> CITY Maw 1 to k Te 4/f ace STATE ZIP Q/y!� <br /> CONTRACTOR PHONE:` 1.— 7 L31�ICONTRACTOR'EMAIL: l� ,�1 % ie C i/ <br /> CONTRACTOR LIC.#(REQUIRED): WE-F- d 01/4� CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 7�/ <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> C TACT NAME: CONTACT PHONE:" f� - 7(- <br /> Hl')bl 0� CONTACT EMAIL:f j orri <br /> AGREEMENT T hereby certify that Isirave 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 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 /> q_s ._--- <br /> ' PERMIT# <br /> .______, ii611 E is - ag 3 <br /> 0 en/, •I•..r4A-/ Signat - Date (Revised 10/12/2015) <br />