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RECTRICAL PERMIT ALIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION:, <br /> PROJECT ADDRESS: S zoy we.fotoce ,+1/4k, eVereit bAk <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 /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ % 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: i u// etectr'c, e" /,t ./1-�,4�,,.p <br /> CONTACT'INFORMATION :. - <br /> OWNER NAME: ,th.yttet4 I; i"/(1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET °)2041 a lm ore /Ale. <br /> CRY EVt.ear STATE WG‘ ZIP 9g?o3 <br /> OWNER PHONE: OWNER EMAIL: <br /> ` <br /> CONTRACTOR NAME: j l�J y CL � <br /> , citA ( -Ds-1J/,GGZj f <br /> CONTRACTOR ADDRESS: STREET 2209 (a 1 " <br /> CITY L . STATE Wei ZIP Z1`(- e" <br /> CONTRACTOR PHONE: a cO f6( 00/f CONTRACTOR EMAIL: b k'Sil /€/tech ic?JL) '/VI-C. re/4". <br /> CONTRACTOR LIC.#(REQUIRED): C-5 i'L% 4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (eCO <br /> sem..,,...._....-�..__._..�.�...�,.-,,..,�..... ...........�w-.,.........�.,...........,.,., <br /> PRIMARY CONTACT: 0 OWNER Ill CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 60 of 0 6 i <br /> CONTACT EMAIL: I <br /> Pktit <br /> s ll;� butes yelac:fri g- / C0144jt c0 � <br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws an 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 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 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 6/77//7 E nt&---/),2D <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />