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/404 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.govlpermits PROJECTT INFORMATION SITE INFORMATIO ; PROJECT ADDRESS: .. .94T)3 � R'j-1'� i 5 /11-()6:-i (oaf& l/, (.of'r L:�2U"S BUILDING AREA(if rre idential,new construction,remodel,or addition)//!-'ice (/I % SF BUILDING TYPE: 991SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: RC Sj Qg/./7R j C'jRI L APPLICATION INFORMATION CONTRACT PRICE OF WORK: " K` NUMBER OF DEVICES(if low vol :ge): FIRE ALARM? 0 YES -A 0 ASSOCIATED BUILDING PERMIT#(if applicable): �7 DESCRIPTION OF WORK: At E-1",„/ f j j/`, - sT/� l-O(4 3 GE .;CONTACT INFORMATION. OWNER NAME: I.p),,3(c 0. GRgrfU TENANT�INAME(If Commercial): OWNER MAILING ADDRESS: STREET ( i) (Q x 123'/7ag- CrrY CV Ef f STATE I,J a ZIP 9R2d b/ OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ,A/146 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC,#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: dOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: pAoA &ReE/.0 CONTACT PHONE: LI-as- %a 3 S'-q t/ CONTACT EMAIL: AGREEMENT:T hereby certify that I have read and examinedTT this application and know the same to be true and correct All provisions of laws 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!am authorized by the owner of this property to perform the work for which application is made and! comply with the State Contractors Law 98.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE 700 C\,` PERMIT* .. ,,,,,, , fry, 3 b -i EI WC( - Z0� Owner/Authorized Agent Signature Date (Revised 10/12/2015)