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ELECTRICAL PERMIT REPLICATION <br /> "ow_ <br /> 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 INFORMATIOk <br /> PROJECT ADDRESS: S Q \out.- tide PL, h,‘ ,13 <br /> BUILDING AREA(if residential,new construction,remodel, or addition) 'OS 0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED V DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 5 Q Q 0 . 0 D • <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT##/��(if <br /> ��applicable): <br /> DESCRIPTION OF WORK: A�Lt)iefe /0 C 2-S•, <br /> pet/AAA,, <br /> CONTACT INFORMATION. <br /> OWNER NAME: IV i COI ' \AA\\ S 0(1 TENANT NAME�(If Commercial):/ <br /> OWNER MAILING ADDRESS: STREET �' 2.��011-op I I 0`--�1.� -1 e C'L_-//a (J A r',1- /3 R <br /> CITY ( -y Lv f- El- STATE ►A//f ZIP I S Z-° <br /> OWNER PHONE: VZ 5 7 5 3 '-//1 T OWNER EMAIL: 01.1/0c4)---e G -e-t Y1VVV�'\�G� , Com^ <br /> CONTRACTOR NAME: A-F-‘04.4 <br /> . TAP)/.: ta- <br /> CONTRACTOR ADDRESS: STREET /T / / b 1 Z / ' 19I- AI <br /> latmAxi. STATE Vit ZIP 7g °2 9 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: rn <br /> CONTRACTOR LIC.#(REQUIRED) To b 25- CITY OF EVERETT BUSINESS LIC_#(REQUIRED): 505 <br /> Uw <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: q2-5 - 75 '3 —11 5'5 <br /> fie. 5- \ 8 CONTACT EMAIL: edk,r.;evi e(eck-ri G - C <br /> AGREEMENT.'T hereby certify that l have read dnd 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 tam 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 /> k,0° 40 <br /> PERMIT# <br /> ��/' • 770( E 02' 00 <br /> OwnerlAuthoiriztr.gent Signature Date (Revised 90/92/2095) <br />