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,ECTRICAL. PERMIT LICATION <br /> - CITY OF EVERETT PERMIT = 'ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov ( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ,25 Sr �r// <br /> BUILDING AREA(if residential, new construction, remodel, or addition) AV SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: Z'( r` ,.0..4.0.'11NOY: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ / C) <br /> NUMBER OF DEVICES (if low voltage): 1�� <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERM #(if applicable): <br /> DESCRIPTION OF WORK: t'_0itp de r) Rey <br /> cc I,1A){�r— <br /> CONTACT INFORMATION 6N 'l ) _ <br /> OWNER NAME: Cc ,bl-/off TENANT NAME(If Commercial): �;��. oupti <br /> OWNER MAILING ADDRESS: STREEFP.R((J `J1a-(' <br /> CITY LT ._ - 4,1 f �i� STATE toot ZIP (t,O?Q) <br /> OWNER PHONE: /IU /f� <br /> OWNER EMAIL: <br /> ...... f$.fi� .,-� ,,,c. .......,.,...� ..,.... :_, _..1-�....,.. -. ....... ... . -._ .... . - -. ,,..... ..._,. ...,.. ... .. <br /> _ .._ . <br /> ... <br /> CONTRACTOR NAME: --�1A /.� <br /> CONTRACTOR ADDRESS: STREET Vier / fjus 1-4,)4 5-t-- <br /> CITY ti-Pk-ark- STATE a ZIP d <br /> CONTRACTOR PHONE: .5- t o- CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): s =0 tri Ot1.1ry CITY OF EVERETT BUSINESS LIC.# •EQUIRED): ( g7 b S MA <br /> wu <br /> PRIMARY CONTACT: PrisOWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: GI' - S7 11 1 UA /, <br /> tiinlP Rei' 1,`" CONTACT EMAIL: S, .< .�- - �C�G�1r7'c? <br /> pvLJS ti Qk. -i <br /> AGREEMENT:T hbreby certify that I have read and examined this application and know the same to be true and correct. Al fprovisions of laws and ordinance 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 /> FEE <br /> t'332' <br /> PERMIT# <br /> E'i,(QO -013 <br /> Owner/Authorized Agent Signature Date (Revised 90/12/2015) <br />