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4177r tilit ECTRICAL 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> iIi e,-32k3 n ,.i rkY F '+ �' -h ij t a4 i,L� * r <br /> - . ,.., ' -_x, . " P:OJECT SITE NFORMA 'IO <br /> PROJECT ADDRESS:'51 o `-; <br /> BUILDING AREA(if residential,new construction, remodel,or addition)eL .l ` 1 SF <br /> BUILDING TYPE: 0 SFR-DETACHED FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ;x I� il"tz ELECTRICAL APPLICATION'�IN RMATION ��, - -- . <br /> iii F Jt .r v, ��i ai.,.: as ,. <br /> CONTRACT PRICE OF WORK:$ ( 0,0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT it applicable): <br /> DESCRIPTION OF WORK: C'cr - c4--"- _ 1/Nib 1 --- j <br /> s CONTA T INFORMATION <br /> 'e� ,, „ i d pis`„ <br /> OWNER NAME: Cif,7 LVL.QA/\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 0 \ VPla....1-x---1 /— <br /> CITY cj.:i j {' - ,. ,, STATE 1 ZIP 1 8-2- -,J�c7 <br /> OWNER PHONE: i� \,..--252.4...,0 OWNER EMAIL: e--Ad 02.0 G C <br /> CONTRACTOR NAME: 1\-- .. ..„)....9.... )_ �_� \6L `.v f <br /> CONTRACTOR ADDRESS: STREET —7 ( k ( A 'Ci iA" r VA✓ t4— ( q <br /> ry CITY L.---1— /h STATE LAI A ZIP 8-2.4..) k <br /> CONTRACTOR PHONE:t'' v1 l 1' `?61 CONTRACTOR EMAIL: 1i LA <br /> CONTRACTOR LIC.#(REQUIRED) (yi - ts—A`Q CITY OF EVERETT BUSINESS LIC.#(REQUIRED)0 '"-1 `-t, 0 <br /> PRIMARY CONTACT: KOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTA T NAME: CONTACT PHONE: - 9-7 i- 22„, , D <br /> `-C L <br /> // (A <br /> 4.,e. , CONTACT EMAIL�—Ij V"e �) t ? k47 ' �. COr-' <br /> AGREEMENT.T 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 <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 lam 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 /> 4 <br /> PERMIT# <br /> �� j--'40'41...... Ob l \ \ . % E i �jOS- 03 <br /> Owner/ orized Agent Signatuier i� Date (Revised 10/12/2015) <br />