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�—! ELECTRICAL PERMIT APPLICATION <br /> -1 j CITY OF EVERETT PERMIT SERVICES ORIGINAL <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 /> al mei ,-„u ! ,..,� �,fttA -�N..� u�'" � : �-fl , , ::o fi r..k VNI.w c :- ^�;`. r�� i -' ..�� n. <br /> _.�.,` _ ' s... <br /> ,, �, •. „„ ata <br /> ...�.r..�,�,t ._ ,. _, .__ <br /> PROJECT ADDRESS:617 \01 i,o-tn rye SE I <br /> BUILDING AREA(if :41(010111, V.w construction,remodel,or addition) 1(lifT ha, t SF <br /> BUILDING TYPE:.SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> s , t�X� � 9 i �id y ; h�, ��,�ri��� � ani p � �'' <br /> � ° a.,.i M� �:r viii k .,g��u tR�C^A A; .,woo,i ttoFifl '�u�.1G i .�� �iiH At, a p u <br /> r� � � , � � ,ire';�� ��� ,�,���. <br /> CONTRACT PRICE OF WORK:$ Ca(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: ,A4j6t CA ' (7)./-1-- hii— 170V77p i v 5-Jj l I <br /> r.... rr ..kA ..; .�` _ P- 'd -y^i:��.S- xr=CONnTi- xxT. io..�:.O5w�a;tt.-�MA.. TIo..$� �4 I..tis—,.t__ .ter SII Ia— <br /> - `-v. , " �.;.. r <br /> OWNER NAME: '1(((A ofviC ( <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET q'i. ct 10 441 five 3 ////77�� <br /> gag,—CITY nCVeJ / J— e/1 STATE /'�/�� ZIP 8 <br /> OWNER PHONE:(�— . /�10I%` VV OWNER EMAIL: Lr 7,C d" tan n - ee -r.....lr <br /> CONTRACTOR NAME: OC V tot Yfl-- <br /> CONTRACTOR ADDRESS: STREET <br /> �`� l ' 7i f'S $(,v 41 J/ <br /> CITY 1.”i/1 0/7-7.--- 1 't y ( STATEVp11-' ZIP )0V <br /> CONTRACTOR PHONE: d)! CONTRACTOR EMAIL: �� 0/2ginu tif{/// I <br /> CONTRACTOR LIC.#(REQUIRED): b ` F ft 31 1-' 0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 46 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> C TACT NAME: CONTACT PONE: i.175--77 <br /> [ ---7!V <br /> Wino lf a �- CONTACT EMAIL: f� �C'1'!(/L_p 1 ar / 6//�l '�( ? ' _'im <br /> AGREEMENT.T hereby certify that 1 ha e r ad and x fined 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 her r not. The granting of a permit ddes 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 lam 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 WAG <br /> City of Everett Official Use Only <br /> FEE <br /> •(. .....3 ._ <br /> i <br /> , <br /> PERMIT# <br /> Ail //ice111 �' E \ QL --02,E-- <br /> 0 ner A g' Sig / Date j (Revised 10/12/2015) <br />