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— 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 INFORMATION <br /> PROJECT ADDRESS: ': 1 5 1+1 5 <br /> BUILDING AREA(If,residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-it OF UNITS: ID COMMERCIAL <br /> USE OF BUILDING; <br /> ELECTRICAL APPLICATION`INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2.-S0 ,o0 <br /> NUMBER OF DEVICES(if low voltage): . <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#Of applicable): <br /> DESCRIPTION OF WORK: ,n^ ' ,(. -1-- fomf) c <br /> rk rer T, t <br /> CONTACT INFORMATION <br /> OWNER NAME: I. 1 IA 1446freri 0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET {LI 111.4 51" <br /> • CITY 1/y STATE I ' 1 ZIP Clgao I <br /> OWNER PHONE: 5 31-15-5770 OWf L <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: CPA 1 r t.0 9 ... <br /> 7'j <br /> CONTRACTOR ADDRESS: STREET I L115 ,jL,l e <br /> Cg-nom ��� <br /> IN leti STATE WA- ZIP 0 20 I <br /> CONTRACTOR PHONE: 7i" { CONTRACTOR EMAIL: 4 e O eCii`YIh - 4.9 , yy <br /> CONTRACTOR LIC.#(REC2UIRED):CAhE:t '%- • I:I/1 CITY OF EVERETT BUSINESS LIC.#{REQUJRER)i I (j. <br /> PRIMARY CONTACT: 0 OWNER rkCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Ie CONTACT EMAIL: d bi ` gav4eitati *cora <br /> AGREEMENT:f hereby certify that f have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances 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 end 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> - ,12,1 -. ttlteiv. s lat-b—t- 19-- Entxo__0(0Li <br /> OwnarlAuthonzed Agent Signature Date <br /> (Revised 9/23/2016) <br />