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May 22 1712:03p Bob Jack 11:W6746777 p.2 <br /> li.i.._4E.FT <br /> 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: /?()4 6A (d"7 r✓ ( e "-o.",re /ht.,t/ <c/-ere e- I v, . gr..u5 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED�yHE1 ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: F COMMERCIAL <br /> USE OF BUILDING: 5- it1.S S ,-,a t/b,L/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ / rfjis. <br /> NUMBER OF DEVICES(if low voltage): Za <br /> FIRE ALARM? ❑YES 54J0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,n <br /> DESCRIPTION OF WORK: / lu•S 11A Nt'LA..) 7, /� 3/714i,..- I'-44fej ukrvrj <br /> CONTACT INFORMATION <br /> OWNER NAME: 45' 6.1' r/4p TENANT NAME(if Commercial): .. <br /> OWNER MAILING ADDRESS: STREET e /t4 f ihd>l.f('of I p I-y-14‘.9 0,. <br /> -7 ).-1 L. <br /> CITY i6 r T IA-Ay STATE _ 6 /'- . ZIP `?`7I 1 Z <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i"o16( 6,4,);,/9 ( <br /> m , .' - •/ <br /> CONTRACTOR ADDRESS: STREET ./� �� Air . /424-7(i to Q of KJ <br /> CITY *-74-4-I*-74-4-I %i--7—/✓- IJ STATE 0,. . ZIP 4'2.417 <br /> CONTRACTOR PHONE: J,• 6,47 35(--i jam, CONTRACTOR EMAIL: 8 ' ek 04ik5 eo e.c 4 icz;,, <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): akl( <br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR E OTHER(Please Specify} <br /> CONTACT NAME: *"` y CONTACT PHONE: 5,.., 5 40 7 53- q 6 <br /> (S CONTACT EMAIL: F ----- r* ( 6v)cco <br /> AGREEMENT I 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 type <br /> of work will be completed whether specified herein ornot. 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!am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCWand 296.200 WAC. <br /> • <br /> City of Everett Official Use Only <br /> PERMIT# <br /> " ___- /--'11. 5-- 2 -0 - / %-.--7 E no -- icb <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />