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&ECTRICAL PERMIT APPLICATION <br /> „ii --- - 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: (00 0 a v w12)0,0,1 cox_ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 1St MULTI-FAMILY-#OF UNITS: -. 0 COMMERCIAL <br /> USE OF BUILDING: Te__,,.. k Qv\A(a I <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage):. <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):(. 3 — l---1\0 "O 0 <br /> DESCRIPTION OF WORK: Pe__? cA('e_ dv_T(e-'S cx vtc Sc_-_,t�cl/v.S, '---G( Jita_ A <br /> CONTACT INFORMATION <br /> • <br /> OWNER NAME: C ...--L.300/6-0 C2 Qv1(r C4ACO UY)TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET )O tt. li Z v13 T� rr , l+ <br /> cm, 1<v 1 l,t & STATE `J ZIP 6)g Q'a <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: O.-•> tJ E. rZ s-nv-=o Ce- a..VC.9- 5ei c..AWb(Sri <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 2-Off, 6 6 ci 6 2 Il CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: $OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: "" CONTACT PHONE: 2116,____ ,,6 al_ 6,z M <br /> &cit o 80 Corke,V%O- VCO(.j`�-' CONTACT EMAIL: nW\C-}V,„Ok A e e;Vt-,1. t 1 <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. Ail 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 tam 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 /> 60 <br /> t►�, PERMIT# <br /> fii,,�'��tnI Icy Izn ��Owner/Autho :,'••ent Signature Date (Revised 10/12/2015) <br /> r <br />