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411P <br /> LECCTRIC A L PIE _ T AI II IUUCATION <br /> �1✓ `r,- 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 j www.everettwa.gov/permits <br /> CJEC :SITE IkFO Wand', <br /> PROJECT ADDRESS: 2- <br /> BUILDING <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: ICOMMERC1AL <br /> ,USE OF BUILDING: • <br /> ELECTRYCAL APPLICATION INFORMATION . <br /> CONTRACT PRICE OF WORK:$ -> / <br /> NUMBER OF DEVICES(if low voltage):. 19 <br /> FIRE ALARM? ❑YES 151 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / 9A/f <br /> DESCRIPTION OF WORK: <br /> ,r-/t/ X-( <br /> cN <br /> . :; - <br /> �AWTACT IImiFORMATION.. . . <br /> .: . . <br /> OWNER NAME: IF `��. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET //e(1Z',{�i S i` ` /J `9 v//��i <br /> CITY iit E 7 7 �/ V i 5 STATE W`/S/ ZIP / 0 <br /> OWNER PHONE: J?` ^ 2 3°1-3 If L. OWNER EINAIL: 47d/Coff. <br /> CONTRACTOR NAME: /% vief toPf4ti /e <br /> CONTRACTOR ADDRESS: STREET //h t/1 % P pJ/ <br /> CIN �1 is- f/ ,5 ' ,,� STATE Weil ZIP-( D <br /> CONTRACTOR PHONE: `/ 74- 2/4f —?j ra2 CONTRACTOR EMAIL: /IL�W. <br /> CONTRACTOR LIC.#(REQUIRED) eteee CITY OF EVERETT BUSINESS LIC.#(REQU ED): O 5 <br /> PRIMARY CONTACT: le OWNER `CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 4 CONTACT PHONE: itZ w' 7- 3/7--a2...- <br /> 40, <br /> 7 2j, CONTACT EMAIL: <br /> AGREEMENT:T hereby ce W 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 /> 5o <br /> PERMIT# <br /> or, t °� Z <br /> 3��� 1 � 1 - 22 <br /> Owner/Authorized ••-ntSignature Date (Revised 10/12/2015) <br />