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4n- ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:2)Ib Pine 3h' , Evere-1 --WA -962t1 BUILDING AREA(if residential,new construction,remodel,or addition) /167- SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: Pjes)d enJaL -ower occupied ELECTRICAL A• CA ON INFORMATION CONTRACT PRICE OF WORK:$ ci ppr ii m• ,' ` $7000 NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES giNO ASSOCIATED BUILDING PERMIT#(if applicable): r DESCRIPTION OF WORK: 1/t-.(1-rico-1. 4 r -1b7 S e JoL add I:b/w, -maj-.er b lrmm), { aE' tubo c x - 07-1sio CONTACT INFORMATION OWNER NAME: /S.,lear) 4.-)5he-je TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 71)O pine.5b'e �j j CRY l� e. ve -H-1 STATE IAJA ZIP gg2U) OWNER PHONE: /25 870-c/339 OWNER EMAIL: %0j5can r75)9er6i1(0 ,-rm.C(., C'OYY) CONTRACTOR NAME: (`��C.�t)N � .l CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): if\' 'AC..--..--- PRIMARY CONTACT: L OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 1-1 .87O,y33 q Z.otSjean h-l3her CONTACT EMAIL: lois jeanJ her, rogr»ci1, corn, AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be rue and correct. All provisions oh. ws and ordinances governing this 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Onty PERMIT# ./ t. A' et/ 7-2 --I E (q404- 2on Owner/A 4.rized A Signature Date (Revised 9/23/2016)