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gaCTRICAL PERMIT APOLICATION <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)everetteos@everettwagov l www,everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ao ti 1-kot6-1,- Ork,/L- <br /> BUILDING AREA(if tridental,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 64fSFR-DETACHED El SFR-ATTACHED 0 DUPLEX El MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Le )i d-fstrki id <br /> ELECTRICAL APPLICATION.,iNFORMATION <br /> CONTRACT PRICE OF WORK:$ 3.(-y0 0 0, o() <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: y ,,, ,k4,AN...0„, TT.woc-ig C— kid Go-CAA:(4 5 5(.,,,V, .\-)a tAL.() MVUoitt- <br /> , <br /> a(-1c, f\e A.0Co...4e. nu,t-L*3 <br /> CONTACT INFORMATION <br /> OWNER NAME: V..,c,1/40A4-,, R-ipcto,(3 TENANT NAME(If Commercial): <br /> ...) <br /> OWNER MAILING ADDRESS: STREET krt., <br /> CRY e„,,Irt,4 t.s , STATE \.;\j A ZIP CcCig t‘ { <br /> OWNER PHONE: OWNER EMAIL: <br /> ( <br /> CONTRACTOR NAME: DCk_ \A-mo(1,fa 4 (6 oriS, 61c-c-ihr;c.,, <br /> CONTRACTOR RRC: STREET : ACSK: lqi <br /> CITY kt/b 11\lekkil Y)OA STATE I ki-14\ ZIP tritS0(4(62 <br /> CONTRACTOR PHONE:43s-11s- tot ii !CONTRACTOR EMAIL: (AIrk 56 Ns.)tyl.v,...tftreo_OrAciik <br /> CONTRACTOR LIC.#(REQUIRED):MCCL14-5E. i 3 D. i2-0. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 014[4410 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) t <br /> CONTACT btuNABJED:wa CONTACT PHONE: kip,'S--)-1 ''''" VA 1%Kik Elvz ek.y\,-(1........ CONTACT EMAIL: rA\ti,‘5 e.i' 3 f V\v kt r--q oma . , (.....owt <br /> AGREEMENT:I hereby cent,that!have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 lam 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 11127,RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> - ; <br /> 41 -:,(ill itaC <br /> PERMIT#O1 - o ( <br /> 0 riAut o'.-- . Agent Signature <br /> Date <br /> E ISt- <br /> (Revised 9/23/2016) <br /> ,..- <br /> - . <br /> • <br />