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ELECTRICAL PEREviIT A UCATI FNN <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.govlpermits <br /> OJEG T SIITE INF it r.Iiiiii In.0w6*;:; .. <br /> PROJECT ADDRESS: C 'O I 1-toy j elve 22Iv•er.e 77 T aao <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 /> ELECT' ICAL APPLICATION INFQRMAT ION <br /> CONTRACT PRICE OF WOR : k b b <br /> NUMBER OF DEVICES(if low vol ge): <br /> FIRE ALARM? 0 YES 0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): r <br /> DESCRIPTION OF WORK: /UCS r. - p cS ea- vrfc e c . l4'J t <br /> . . ..�:-..dr9IetFORMATION..,..._: :.. <br /> OWNER NAME: f'(?FF .C! A( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /WO 1 ql T©y 7 41"-( <br /> ) ©I HeyG7 G{f/-Q cm( v--ei-e i / STATE k,,414__ / t)ZIP 20 I <br /> OWNER PHONE: ,..1 �S_..��.5—53I /„ .OWNER EMAIL: <br /> CONTRACTOR NAME: Co fr-).70.-7((G1 j 7k Lec`7 ;c £C C <br /> CONTRACTOR ADDRESS: STREET /J (' <br /> PO t Dox a?(l CITY Ni t4 Qw� STATE b9t. ZIP Ts/,2Jr <br /> CONTRACTOR PHONE:(125-17s-al Zp CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC,#(REQUIRED),N j t_ 5 ieyeiaAf CITY OF EVERETT BUSINESS LIC.#(REQUIRE 6Jt' D, <br /> PRIMARY CONTACT: 0 OWNER I ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <12S- v c fs' -•-S3 79 <br /> elf- 0150 0 CONTACT EMAIL: <br /> AGREEMENT.-T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions oflaws 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 /> 1FEE fe <br /> W ...-- _ <br /> 1 PERMIT# r <br /> ,/ <br /> ner/Authorized Agent ignature Date (Revised 10/12/2015) <br />