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4m- ECTRICAL PERMIT AF _ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> /� PROJECT/JSITE INFORMATION <br /> PROJECT ADDRESS: I�Q l I ( 9216 J1- EU�Xa/i-7L <br /> I (�f <br /> BUILDING AREA(if residential, new construction, remodel, or addition) _SF <br /> BUILDING TYPE: FR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: j0.) <br /> . 11(\_9_, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 10% <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES I 410 <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: YOU re StIAN01St MCI 1,001V Y� qi \OAth, 1 <br /> GOD,4(\I Ad C-:''til- r/1C V x.�7 f'I l l �I � <br /> CONTACT INFORMATION <br /> OWNER NAME: I.1l� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /I IQ I� �`' G-1-- p)� <br /> CITY C��VC pA(C4 STATE ZIP V !/2_6 <br /> OWNER PHONE: �' OWNER EMAIL: Al//f <br /> CONTRACTOR NAME: I\ \I ng (-, JO"kY-I -Kra v I C- 5 <br /> CONTRACTOR ADDRESS: STREET 930 /n_ �h r 5 LE (/� �pJ�J(��{�J�Ej <br /> cITY "'�` 4/���yy-,✓/ G v i c2 STATE `�r S ZIP ✓ (J <br /> CONTRACTOR PHONE: ( (-125) 7(0(� 17ZV'J✓✓✓ CONTRACTOR EMAIL: t (AL 4 6 'n Y l cs-eL/x "t-r1C J,1� ,I} n, <br /> CONTRACTOR LIC.#(REQUIRED): \N G S C\ &. <br /> 2- G CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0 1k1`"1\ CI) <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: VQ CONTACT PHONE:( l/1 251 U?A9 1) 12 <br /> "V �' CX <br /> CONTACT EMAIL: �1Y /y// S / 0 1' I dl / , •• <br /> AGREEMENT T hereby certify that I have read and examined this application and know the same to be true and cor ct. All provisions• laws and ordiee ces 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 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 1/227 <br /> % - 8 <br /> / PERMIT# <br /> k/12-3//b <br /> ' 3//b Eli 1 Gig-OCA \ <br /> Owner/Autheri e Agent Signat a Date (Revised 10/12/2015) <br />