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4rE77 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 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2c*s 30 ..,c(.4 MT•A 1 AJ <br /> BUILDING AREA(if residential, new construction,remodel,or addition) Sfs O SF <br /> BUILDING TYPE: ZI SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: S(= <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ / <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 1 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: C 11-9 i.-Ce."(K)G Atl dK-1 L i(,if i 4 PLUG 4 <br /> Q I <br /> 4,3c, cCy tr 4 It - ?Luc, <br /> ti--1 FL$L I)QM ( KNCAN L.t qtri ?(,-(2<,1 :'wirc J <br /> A Do 3 SCco tri= 02,‘ <br /> 3- /JELL) titc,LticS <br /> CONTACT INFORMATION <br /> OWNER NAME: =Cg TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,,3 20 E �11 _LF R4C�t- �1Z <br /> crrY j_V -� ` STATE LON ZIP 98 <br /> OWNER PHONE: 1 I$ 2 9 3- (Q(Q(D�� OWNER EMAIL: <br /> CONTRACTOR NAME: IAGb« \y C1 �S (2..k(-. <br /> CONTRACTOR ADDRESS: STREET/ .35./.S'› S F'C 4J i/_( ,S C <br /> CITY PQ OX=—CC— STATE 1.9.51IN ZIP q 8' Z O J <br /> CONTRACTOR PHONE: y a. 3� G - CAst93 CONTRACTOR EMAIL: N)�b l h1\ f (::'( C, cR CG C'& �'�,It'(L <br /> CONTRACTOR LIC.#(REQUIRED) t�t cb(�t-coo 3{fJ " CITY OF EVERETT BUSINESS LIC #(REQUIRED) &3 a` 3 tO <br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: qag 3b8-0693 <br /> CONTACT EMAIL: <br /> In.kt 1 Gt m <br /> �-C�(���CS��xt= <br /> AGREEMENT:T hereby certify that I have read aid examined this application and know the same to be true and 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 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 /> OD <br /> PERMIT# <br /> Owner/AutTiorized Agen tui -. Date (Revised 10/12/2015) <br />