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se- ,---- ELECTRICAL PE'i"IT P—'UUCAT O <br /> - ,- - CITY OF EVERETT PERMIT SERVICES <br /> �' f 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ] (E) everetteps@everettwa.gov] www.everettwa.gov/permits <br /> PROJECT SITE INFORMATIORI <br /> , <br /> PROJECT ADDRESS: J 3 05 1 9 +h ST <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: 0 COMMERCIAL <br /> USE OF BU <br /> ILDING: � E. _. .. <br /> ELECTRICAL.APPLICATION INFORMATION " :.. <br /> CONTRACT PRICE OF WORK:$ &©C) . <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: UJ i r•(,sr. -OC' ifedu.i ''\t f ee,AC c_ L C-1' 5 a't' C( AS'J <br /> - CONTACT INFRMAION ...: <br /> ry)I ,Q t 1 Cob A TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET ���eeej 305 )L( eR'N J 9 '"� 1 <br /> CITY L V` ,-.4-it STATE �� . ZIP b _,c3 1 <br /> OWNER PHONE_ Y 5-039 F-08 I 0 ,....OWNER EMAIL: .. .., .... _ .�._ : ...�......., .. ......... _. <br /> CONTRACTOR NAME: •(--QSS 1 'E.l()Chi C>I Go . <br /> CONTRACTOR ADDRESS: STREET l •0 , 30ex el Li 0 <br /> jj CITY €v,,Qv-..Qii' STATE�� ZIP C\(6M) <br /> ? <br /> CONTRACTOR PHONE: —3-39--;;;')~�3c) j CONTRACTOR EMAIL: dos,i..,. vcnss j+N IQ) ^AST. c\4 ft' <br /> CONTRACTOR LIC.#(REQUIRED)• kc-cA 6G "�� Cr' CITY OF EVERETT BUSINESS LIG.#(REQUIRED):0 SO I � � <br /> PRIMARY CONTACT: 0 OWNER Aci CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L fD -7 5 9 (.9 J <br /> boopt 1 Kosski 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 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 WAC. <br /> City of Everett Official Use Only , <br /> FEE <br /> 4715," <br /> PERMIT# <br /> 1111 1 2,_e_:____s 3-3I - ) LI F ) !ga3 - 2,0 <br /> •caner/Authorized A ent Signature Date (Revised 10112/2015) <br />