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4E77 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 ] FAX 425-257-8857 I (E)everetteps@everettwa.gov] www.everettwa.gav/permits <br /> . ;PROJECT::S TE.; <br /> . .... ......... ....., .......... ION : :::: ::::.. . :::......... . . :_:..... . <br /> PROJECT ADDRESS: Q?j a0 3' )Q rrJ by-, <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 1 a,00 SF <br /> BUILDING TYPE,SFR-DETACHED ❑S TTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL _ <br /> USE OF BUILDING: 9.4,S1r401st(' <br /> ::: s' :; ::. ...; ::,;:.::.:. :: ;:....y`ELECTRI•ALi ::......:::::.: ....:.,,.::..y..:..:;: .. :- <br /> ......: ........... .:......::...:... .-:.. :..: APPLICATION;INFORMATION ::::.... . ::: ..:.... ...:• ::;;::.: .:: -:. .,..:::. <br /> CONTRACT PRICE OF WORK: $ 4010 (`M <br /> NUMBER OF DEVICES(if low vo age): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT if-tlicable): <br /> DESCRIPTION OF WORK: Pan01 ClX1n L, r OAd, c ir[Ailt` 4- MI riiroJh©nnt brA,N., pivot) <br /> .. . . ::.:...:.:.:.....,,.:.. .:...... : ....:.:..:„... ..:. ..:.:......::::-.„::.,..,.....CONTACT:INFORMATION <br /> OWNER NAME: potiy-'‘(l i✓ DA e,,a TENANT NAME(If Commercial): <br /> } <br /> OWNER MAILING ADDRESS: STREET 2,,, 0 S ar vy I r. <br /> r��-J Cr1? ���,/T C7�^- STATE 1/�f 14 ZIP C R A „i <br /> OWNER PHONE:14 Q -7aa- i 5t t0 OWNER EMAIL: Pai(inej 4Q17.ut a@ rnn cr ,(fir-. <br /> CONTRACTOR NAME: G, E S H Q c lnab' ~1 <br /> CONTRACTOR ADDRESS: STREET ALI 0 Ci 5�(�,tp A� (� t <br /> �y <br /> Cn ej V f rr t STATE w A- ZIP CEJ <br /> CONTRACTOR PHONE: /4 as-�in-4a51 a + CONTRACTOR EMAIL: Sara @...5 hen-lir-IA, r oryN. 1 <br /> CONTRACTOR LIC.#(REQUIRED):C/S4T( SW gA..)RAC. CITY OF EVERETT BUSINESS LIC.#REQUIRED) )1 Glip .g <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) / <br /> CONTACT NAME: l CONTACT PHONE: Liac....1f 0_�a,,C5`) <br /> Sn olt 111 t/ I/ll"ll CONTACT EMAIL: soo fa o c c t't,lt�Q7`7 0 C4` ,r NI ..Y <br /> AGREEMENT:I hereby certify that l have read and examined this application and know the same to be true and wired. All provisions ofle's 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 298.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> jp.,/0- P <br /> -an -iF E MO(.0 - V- <br /> OwnerlAAgent Signature Date (Revised 9/23/2016) <br />