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ILECTRICAL PERMIT AFILICATION <br /> �- 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: <br /> \ /.,,i-6.,j ,L %/?C) %/v,9- At-/ VO--C92-- <br /> BUILDING <br /> BUILDING AREA(if residential, new construction, remodel,or addition) C)00 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: IJ-t MMERCIAL <br /> USE OF BUILDING: /l��„fl'7 ./vy./”. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2���h <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES afro- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: A6 0 4 e11- -7i 1e.44-'-'- -` #77 <br /> c,94,7ii <br /> CONTACT INFORMATION <br /> OWNER NAME: loti/!2 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> ����JJJJ 3 Z�/ s 7 �S/r-jc Xk C <br /> /- CITY 41"1";1 STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G. l"i,1 ��`�, //C., 2-G (.. _v <br /> , <br /> CONTRACTOR804) <br /> ADDRESS: STREET 1/11.&,.3 2' �! (� U/ <br /> CITY STATE //(/1� /� ZIP 9 -24,..5- 2.._ <br /> CONTRACTOR PHONE 3 ,. <br /> ")c3 9'/"' ,....7.-- CONTRACTOR EMAIL /e)j it -fi--` ir"s'7 p//Jc%a/4/ i'"tC.c,/ <br /> CONTRACTOR LIC.#(REQUIRED):8o %l g _ / 1M <br /> L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 764 '® <br /> PRIMARY CONTACT: 0 OWNER IR-CONTRACTOR 0 OTHER(Please Specify) <br /> CONT/AC`T NAME �j CONTACT PHONE: t:3$?' <br /> l /✓� 9 <br /> /'7' T <br /> ) /&, -- � %�G.„-„, CONTACT EMAIL: l <br /> AGREEMENT..I here certiify that I have readandexamined 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 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 /> PERMIT# -- <br /> 7 / --:' _ /i -Z� E fl 0'7 - I 17 <br /> Owner/Authorized Ag- ignature Date (Revised 9/23/2016) <br />