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ECTRICAL PERMIT APLIC <br /> ATION <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 1 www.everettwa.govlperrrtits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: -1-0 S WI <br /> Per. ( ✓(G,[ ()10 u d f F v Z✓e t.6 W A- 1 ,4 Z0 3 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ;�ELECTRilL"APPLICA`l`I N INFORMATION <br /> CONTRACT PRICE OF WOR •$ LD OC-) <br /> NUMBER OF DEVICES(if low voltage . <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ADO 1Z-64-CPT/lc-LC -FOR- FaCE.PLAC- <br /> i7 CONTACT INFORMATION <br /> OWNER NAME: tW�EJL�' L1.-(-1-T O-r- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 77 05? (.AP tom- e.. ,D ,27Q <br /> CITY it.&TT STATE L,Y4 ZIP 1203' <br /> OWNER PHONE:- ( -f as) 3Z2 --`E'' OWNER EMAIL: <br /> CONTRACTOR NAME: VATIOFIC43%- &L6 CP/Z ( <br /> CONTRACTOR ADDRESS: STREET (2,3&q eqz,p2ec. ,DL. <br /> CITY g%.,.(c, l'1-r1 G o cc- STATE OA ZIP ' 233 _ <br /> CONTRACTOR PHONE:�66/ 3(g -6 i t-1 CONTRACTOR EMAIL: Tt)c..6"--(/Q,. ell. --�,C,wi . 4-r---. <br /> CONTRACTOR LIC.#(REQUIRED): V4«'0E hCj$pc- CITY OF EVERETT BUSINESS LIC.#(REQUIRED):M-F <br /> PRIMARY CONTACT: .OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: \ / CONTACT PHONE:(, ) 3 1 . -G)ZZ, <br /> N L6(- `V'�- '"oal CONTACT EMAIL: <br /> AGREEMENT:!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 1 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 /> IsillCity of Everett Official Use Only <br /> PERMIT# <br /> k7, V t 7 E & Z — \9 <br /> L4 <br /> Owne , horized Agent Signature Date (Revised 9/23/2016) <br />