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LLECTRICAL PERMIT AI 11 LIGATION <br /> ,_r, 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 I www.everettwa.gov/permits <br /> PROJECT S#' '�.1NFORI't1tiAT1ON' <br /> PROJECT ADDRESS: 4\0? >1 taw g L9 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF • <br /> BUILDING TYPE: 0 SFR-DETACHED IF SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> (ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 76 56 • <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):/J <br /> DESCRIPTION OF WORK: ® R <br /> „CONTACT,INFORMATION- - <br /> OWNER NAME: jti --35)y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> coy STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> % <br /> e f' <br /> CONTRACTOR NAME: /k/ • .& . . . . .... •. <br /> CONTRACTOR ADDRESS: STREET 553/7 /C/ ST Sr $i ) <br /> CITY O✓( a/eC 7Le!� STATE t-L)� �1f ZIP ? F 73 <br /> CONTRACTOR PHONE: '/25'- 387, 9'3/e CONTRACTOR EMAIL: RA) CLE.CryC Q'V4-4/OC. Cog <br /> CONTRACTOR LIC.#(REQUIRED): i ZL 2 ,9V„,2.7-( CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Sq'*-1-5 1 <br /> . <br /> PRIMARY CONTACT: 0 OWNER . 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: zi CONTACT PHONE: V95- 317_ ?3Z� <br /> ea <br /> CONTACT EMAIL: , \t5 ��-� � - <br /> AGREEMENT:T hereby certify that!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 l am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.20b WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 100 <br /> PERMITT SoZ - Q1-4 <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />