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°4b-n' ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT':SITE"INFORMAT#ON r ...... ' , <br /> PROJECT ADDRESS:IO(62( St Dr n " etc* 1 Vv1 t 4)02-1 <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED itiSFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: &\i CJ,k'e -P/ii( U kovto n or <br /> ELECTRICAL APPLICATION INFORMATION 4' ' <br /> CONTRACT PRICE OF WORK:$ I,r J <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES a NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: MO amp pane( Ohot hor(e 0-11fi <br /> CONTACT INFORMATIC)$ <br /> OWNER NAME:\) C'1 ' rJ vi Y t1TYtr TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> ���I!++0�^`//TI/y21rl1/y� I St De (c e- <br /> 1/�'ry��} /�/J <br /> 'n�n CITY v " V• V /� STATE y v 1 ' ZIP al Q V i <br /> OWNER PHONE: (7-00) le(-O 9-929-2-; OWNER EMAIL: N/ A <br /> CONTRACTOR NAME: I n - 01, e V1/)C91 I (rl• rV I Cei t ( ill V <br /> CONTRACTOR ADDRESS: STREET IS 120 1 t1-11/1 J R. V G <br /> 1,01 y 6i S STATE �\}YA ZIP 9�y" <br /> r-✓7(/V <br /> CONTRACTOR PHONE:( 3 )ITlo" ('Oe (o/ CONTRACTOR EMAIL: C 14^dI S @ i11 Ll b141P/e( 'i / •604-4 <br /> ��,q, qr ,q�/ <br /> CONTRACTOR LIC.#(REQUIRED): I N 4 V V i ES"I✓Z Q G CITY OF EVERETT BUSINESS LIC.#(REQUIRED)O`�Ll/le e <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: S- n CONTACT PHONE: ���5�� � �`/.�,'I <br /> ✓�l� CONTACT EMAIL: T-f/ <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true af, correct. All provisions of laws anUrdinances governing this type <br /> 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 /> 1111 PERMIT# <br /> ia / ..J✓ /7 /6 <br /> E 1 �< < -- b� � <br /> • ner/Aut'ori d AgentS'•S . ��� Date (Revised 9/23/2016) <br />