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04' ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> _ 'U r ss;a 3.v,m�5.' R <br /> PROJECT ADDRESS: Sri30 5PG1 or51- ,4ije. 5Vef e'H- , (.n/ /{ q 82o <br /> BUILDING AREA(if residential,new construction,remodel,or addition) Resi dam+;a I SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED IX DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Qe S i ae..Ace <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 8 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): AO <br /> DESCRIPTION OF WORK: Rt_pltz(e Ito avvtp Mem pet ck <br /> OWNER NAME: Alkle„1 TENANT NAME(If Commercial): ----- <br /> OWNER MAILING ADDRESS: STREET S430 Sct;1,jy 4- <br /> CITY tT I e•Lt,F . STATE k„ {k ZIP 97_,D 3 <br /> OWNER PHONE:(20 2) (618— OWNER EMAIL: <br /> CONTRACTOR NAME: D0(c7 6leC.-fri(4 ( SSV( C-e LLC_ <br /> CONTRACTOR ADDRESS: STREET Z"j 0 1 M. G U j t.S V rt. <br /> CITY EV Q..-(- l l STATE ik ZIP 1 8 203 <br /> CONTRACTOR PHONE: LI 2 5-2 32-13 01 CONTRACTOR EMAIL: de(LIZ e <br /> CONTRACTOR LIC.#(REQUIRED) pet Z e.e6 824 el! CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> ,mr« � , .. <br /> PRIMARY CONTACT: Iia OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> - <br /> CONTACT NAME: r,, CONTACT PHONE: z/Z5 2,3-z- i 33 o ) <br /> 1411.4,e,a Ca4t_ CONTACT EMAIL: <br /> dadZe (eC.-Fr+c@ cf,�,nai t .c. +neL <br /> AGREEMENT:f hereby certify that I 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 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 /> PERMIT# <br /> Ze..,,-) _ /60g E t? o'f-foo <br /> Owner/Authorized Agent Sig ture Date (Revised 9/23/2016) <br />