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_ECTRICAL PERMIT AP ECATION <br /> '111°P'A4 -' —' .--A <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 } FAX 42S-257-8857 I (E)everetteps@everettwa.gov 1 www.everettwa.govfpermits <br /> PROJECT SITE INFORMATION <br /> • <br /> (PROJECT ADDRESS: 11(e `ta"'S,il-•C. 4V R ,� <br /> G+'G� i �r 1 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY #OF UNITS: M MERCIAE <br /> USE OF BUILDING: Gick: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ IZy 14 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? D YES fQ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: .T.vsk 11 1 QuAj et +.F a- I C.i ' <br /> Acui A,161 f ti=ne a' +7ervivr .; e - A bte. <br /> CONTACT INFORMATION <br /> OWNER NAME: •Ftov;cQG.sa c.t.. tan1 AA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> crw sTAre <br /> zip <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: V:tC.A Etee..-1r;c.. _ <br /> CONTRACTOR ADDRESS: STRWT TO Srpe. et:}44 1- <br /> CRY f� ere t%J ' as 4143166, <br /> CONTRACTOR PHONE: 2414-1436-5200 'CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQIiiRED):Vt �l..S 2-M,'�,3 <br /> 'cm OF EVERETT BUSINESS uc.MRI~OuIREn}:08494 SS <br /> PRIMARY CONTACT: 0 OWNER <br /> `;4CONTf?AGT4R 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zt1.-e3SC " ' <br /> '* ii51l & t .)a CONTACT EMAIL <br /> AGREEMENT:Theta � +�'� � t3GcI��tE.b C.:.-, �`gC.�.CA� { <br /> by oertlfy that,have and examined this application and knowthe same to be true endconed. Alprovklons of laws and ordtnencesgovemfng tisk <br /> fype or work we be completed s*etherspeefired herein or het The granting of permit does not presume to Ore authority <br /> local law regulating construction or the performance of construction. That i ern arrthcrized byfhe.osmer efthis *latem orCancelf r the provisions(early others I or <br /> comply wiHi the&ate Contractors Law 18.27 RCW end 296.200 WAS properly to perform the svorkfor which apRikabon is made aril i <br /> City of Everett Official Use Only <br /> FEE <br /> 42_Z °_,(2, <br /> t <br /> / f [ <br /> PERMIT# <br /> Mat <br /> 1 <br /> hAgentSigsietare n 0 z()q <br /> D ` (Revised 90!12/2018) <br />