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kECTRICAL PERMIT AiC aTI <br /> oies: _n_A__ <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 i (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROTECT SiTE INFORMATIOimi`. <br /> PROJECT ADDRESS: a- a- Wth220)-e eife *e)- 7'1 V/4/ qa <br /> BUILDING AREA(if residential,new construction,remodel,or addition)1000 SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> I CONTRACT PRICE OF WORK:$ 12.0D e <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> , DESCRIPTION OF WORK: 09 D047- !421/A/ CTR/G4 ‘450(, A JD GVIT2E,A4 <br /> /re- Eiti %v'Af6 Roots 1 L-/VJ A/� ROOM/ l 11 , 4WD �7 Z2Z�X1 <br /> (Affiw%iti S,06 A-7-- 7-0R6. ,.. LSO s iilvti G4 ?70'' -r0,2 lyA/V t ;2c, <br /> CONTACT,INFORMATION <br /> T.OWNER NAME: ,?// 6 c --/-friacnel. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET , --,:g?42 W..- ale _A-0-e-i2Ue �a /�(�2� <br /> {- Q CITY * --1/(&)-C11-- STATE U'1'J * ZIP %00)/5 <br /> OWNER PHON l�7 _111 • tOO WNER EMAIL: <br /> CONTRACTOR NAME: 0A1j ER <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 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 /> 4 I Db d� <br /> 1 \ PERMIT# <br /> 45 -t\ , mon. ©-- ®y .©i,P E 12)04-0510 <br /> caner/Author• cl• - • atue) Date (Revised W/12/2015) <br /> t <br />