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"11°P/v"--,4 LLECTRICAL PERMIT A__IWICATIN <br /> � <br /> 1�►/�;�f CITY OF EVERETT PERMIT SERVICES <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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: /2.76 6 &r/J. ./f e4 f 1,/, '14)A1 lifit# , tAj 09 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED-D � 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: P<OMMERCIAL <br /> USE OF BUILDING: %',_�:g. <br /> ELECTRICAL APPLICATION INFORMATION. <br /> CONTRACT PRICE OF WORK:$ 35-0 0. OD <br /> NUMBER OF DEVICES(if low voltage): /OM <br /> FIRE ALARM? 0 YES 12:410 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): //y <br /> DESCRIPTION OF WORK: ! e XJ re)kveJ (� LLTh -PAcOtIA-OLI- 4642, <br /> CONTACT;INFORMATION ; . <br /> OWNER NAME: r ,,,5& 8A L /Ck,,,it ..(4 TENANT NAME(If Commercial): 0 Ag <br /> OWNER MAILING ADDRESS: STREET 19 is A)obit ,�ln(1) <br /> Crit/ / (j�'ve_/e.�'+Q-) STATE Oki ZIP L11-1 1l L <br /> OWNER PHONE( Z3}...q ile G <br /> .. g ( ) ,. OWNER EMAIL: 10/i) <br /> . , ll//. . .. <br /> CONTRACTOR NAME: irk.)d( ,J�./ 2'.------d S p4 )) / <br /> CONTRACTOR ADDRESS: STREET / q J U l /LI/ sT /46( <br /> CITY t4)OOCQ th y.14' STATE L//j/� <br /> ZIP ?,go 72 <br /> CONTRACTOR PHONE:(4'2 gob -9 2,0,..) CONTRACTOR EMAIL: ..I g e N(,J 2=.4`50 n , (Q V <br /> CONTRACTOR LIC.#(REQUIRED): id Q e--0J /../ Qs 12. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Q 5-0(09? <br /> PRIMARY CONTACT: ❑OWNER [CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N E: CONTACT PHONE: 2�) 0.75-7 1 7( <br /> . A a tM S{/)LJ CONTACT EMAIL: �i4/l se ,i W 4,-.----d;.50,-) - e'e?M <br /> AGREEMENT:T hereby certify that 1 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 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 /> 4 )un.Lo,....., <br /> PERMIT# <br /> 2— /t/ ()/ 7 Efty)_ - 07 <br /> 9 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />