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0477 • ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Io(oz7 /q 114 AVE E <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 7-5'(2f-7 SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: �B <br /> ELECTRICAL.APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Ltzoo <br /> NUMBER OF DEVICES (if low voltage): 2n <br /> FIRE ALARM? YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: Fins ALAfLi' (-MA kg 1morzovEN'ETJT <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 51Ws& L W± 02T14cD <br /> OWNER MAILING ADDRESS: STREET )U62 1 15rt14 Av Sc <br /> CITY EV G41..1^TT. STATE WA ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: fj 4 14 r-iR-E AM° SEcv21Ty <br /> CONTRACTOR ADDRESS: STREET Qo gpx 3.7/( <br /> CITY A Rt.I N c,To ItJ STATE W ZIP 9'21u.3 <br /> CONTRACTOR PHONE: i-►ZfS 2c/+( /L/ti 5" CONTRACTOR EMAIL: "S'U—f SN H f IfLE•C,oY •N <br /> CONTRACTOR LIC.#(REQUIRED): 3H P►2.1Ft-fa .AA) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): s<loef`/ <br /> PRIMARY CONTACT: 0 OWNER Vt,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lt 25 24 <br /> S tJ i aaoSSAIQO CONTACT EMAIL: EFF c SN F(Fi eG•Lt7N- <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 I am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> i3 ) E isoa - oq-Z <br /> Owner/1'-' <br /> ge t Signature Date (Revised 10/12/2015) <br />