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4m' ELECTRICAL PERMIT APPLICATI tin <br /> CITY OF EVERETT PERMIT iGINA <br /> 3200 CEDAR STREET, EVERETT, WA 98201 , , Fi <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ro <br /> ^ i u� i ,d �wm .,: dn � � <br /> fit ,• Q liic <br /> PROJECT ADDRESS: �/1( ye( 67 J <br /> BUILDING AREA(if residential,new construction,remodel,or addition) C/50,1/1 ii 1 SF <br /> BUILDING TYPE: 'SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> _ R:EL Kt:0 /R1 O CA, ON IN(F :RVAT10 F ��k,,, ' <br /> i P3 �x�r � e,�.�:wHk�k.���� � �... nx G:.v.xz ti.,.�,a�n; 'pgrw x5;�. A�a 8��� �n�H•�i rd'�i�aHiti+ttvst�"� h w�',,a^�'^wE.��..,.a. � 4�.��a iht.� . '� �.,. e <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: MQCI,(-NC`((CV 1 Worredi -- ,ji )0*ll d ! <br /> odd Ci►-CAA -fir 1O t (� t 1 <br /> � � ti 1 <br /> � �an tlasO o �m fl ' ot ,, <br /> bi^ <br /> F <br /> OWNER NAME: 4.(S611, <br /> FOr TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET C- II, f pr,VsPrWCITY iV`GtSTATE(,fit— ZII (/ /L 1 <br /> OWNER PHONE:145-371 (-ca 1 OWNER EMAIL: AJ " <br /> CONTRACTOR NAME:15 Aie, ftirn <br /> CONTRACTOR ADDRESS: STREET-7 It C 718+-G (/ <br /> CITY Hoovi 1,.)'.V1 ( STATE IA) ZIP.vg /3- <br /> , <br /> CONTRACTOR PHONE: _I,!/�� 1_ ---/ -3ci CONTRACTOR EMAIL: h ( c)itiQ 4 O a/ -(1 <br /> LI <br /> CONTRACTOR C #(REQUIRED) i S,, ) K CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �( [� / <br /> PRIMARY CONTACT: 0 OWNERCONTRCTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> - ,1 �D„riri 'Gob CONTACT EMAIL: IhUie__AM,' <br /> il -C <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 /> ()f' <br /> / PERMIT# <br /> l /1F 31 , E 10-3- -- OC 3 <br /> Owner/A .. ..S = - ure / <br /> / Date '(R@vised 10/12/2015) <br /> I <br /> i <br />