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aECTRICAL PERMIT A LICATI®N <br /> .1►�j " CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION'` <br /> PROJECT ADDRESS: a 1-71c-, 3 U j(16( \i¢:\ <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: e�1 ike k CCc'i <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 11%36 0,-0Q— <br /> NUMBER <br /> f ?NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): (, <br /> Ut <br /> DESCRIPTION OF WORK: �,� �p pt c,C‘ 2 Jai,i, JNcv\ - T o,ri \ 0,4 V)J`re�1� < <br /> CONTACT INFORMATION - • <br /> OWNER NAME: Cj \)Cr, P,r 11 0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t91 3 u N( ' (\'01 <br /> CITY 0-Os-Q. �J STATE meq, ZIP gq 2D t <br /> OWNER PHONE:p9 Bc "o`SQ-""f OWNER EMAIL: <br /> CONTRACTOR NAME: 1 i QSS tit) Q(,,,E,+c1 P r, , CO <br /> CONTRACTOR ADDRESS: STREET ' , ©. y( T(--t 0 <br /> CITY Q jOc'Q STATE L ZIP q ?) ©(o <br /> CONTRACTOR PHONE: 1-1,Q5-3' ^�3.9 ( CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): ra$Sq„G?fr.) ft,' CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 056/6.S <br /> PRIMARY CONTACT: 0 OWNER KCONTRACTORYIM14❑OTHER(Please Specify) G... _�..,..�."..u_.�_.�.. <br /> CONTACT NAME: CONTACT PHONE: i-t<eQ ---?5-4/- ag 6 1 <br /> DQ tom) (KGSS(0 CONTACT EMAIL: <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 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 /> 110 <br /> PERMIT# <br /> �- F9- IPS (SO4 - t (,0 <br /> •ner/Authorized Agent Signature Date (Revised 10/12/2015) <br />