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41...ECTRICAL PERMIT .P—LICATION <br /> I4'►',� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION: <br /> PROJECT ADDRESS: 6 bo 3 /6NJ/¢j!/4 b IL <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> Vivd 4 ,)0(1 74jf,' /0(4, 0e- •mat v <br /> CONTACT INFORMATION <br /> OWNER NAME: /guS70%/6 Gustcpet TENANT NAME(If Commercial): <br /> OWNER MAILING"ADDRESS: STREET �.0. eq�' Z.2 <br /> 'l 4i/L6 f CITY STATE (/ ZIP &2 7O <br /> OWNER PHONE: 'i).4 .- 76-45''S% OWNER EMAIL: /14,047/ 'l L( H/L ate? <br /> CONTRACTOR NAME: iev9771.4c .jSyoe <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE:4Z'' .Q76-bs-S/ CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED);5?)4f 9).C (Cy CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: &OWNER 7 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lc 2'f""—8 7r 6..6 s-Sr-, <br /> /AiL 809? 4\ CONTACT EMAIL: <br /> AGREEMENT:T hereby certify 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 I am authorized by the owner of this property to perform the work for which application is made and <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 0jQ4'kcAuthorized Agent Signature Date (Revised 10/12/2015) <br />