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' .._-:___:,, ELECTRICAL PER) IT AWILACATION <br /> j _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORM`.TI...N,s. <br /> PROJECT ADDRESS: kl /' .. ..:Noe fide... ..:J F,�u /LII J v..69:- rao t <br /> BUILDING AREA(if residential,new on uction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> RUSE OF BUILDING: g ;LW/ l //94 • t <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 1(0 0 0 <br /> NUMBER OF DEVICES(if low voltage):, <br /> FIRE ALARM? 0 YES IDNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: .` . . 4 A. '� ,.: /_' v /' a• <br /> c_l_ge- ILO too ' ' . <br /> wo M <br /> a 01* aLfr 74 .V'110- t ot <br /> al... O// �� On 2- /n 41,10/4-- a/ - io ai <br /> .......: ...... .. ..:. ... .. : ... <br /> CONTACT INFORMATION= <br /> OWNER NAME: 44 . / • 0 ' a/L4/a/1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET )., Al �4••l 04LJ <br /> ,�, //��/ CITY 4. c: STATE de. <br /> , ZIP Zi. . <br /> OWNER PHONE: . ,4 b 3p)0 . OWNER EMAIL: $Q.(.(� Q�/(ft J ill/e. ‘) /v),,,' ' cf/7 • <br /> CONTRACTOR NAME: &/)t . <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: " <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> , u <br /> PRIMARY CONTACT: DOWNER 1'.NCICONTRACTORW `❑OTHER(Please Specify)WIz�-..,.�v,�:. .,:.....�,,,...r_..,.._._•.._.,,m.,�..-�<...�.v.v,...........__...�.:.... o. <br /> CONAAFT NAME: CONTACT PHONE: 2.40 6 x '7© LTI <br /> (041661, • d• %wJe-. _ &CONTACT EMAIL: � M ^ • ."- • , <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be trund 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 /> i 4 \DID a I <br /> I <br /> PERMIT# <br /> 0 e#449/g • Elts0 — 12) 1 <br /> Owner/Ruth Ized,igent Signature Oaf: (Revised 10/12/2015) <br />