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,IPA4v—,A LECTRICAL PERMIT Al4K,ICATION <br /> foor <br /> mitil <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.govI www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION'_ <br /> PROJECT ADDRESS: Z-(�Q / _we-, (,9�-- Z`8Zo( <br /> BUILDING AREA(if residential,new construction,remodel,or addition) L g' SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX CI MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: CZ/rt. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ e • <br /> NUMBER OF DEVICES(if low voltage):• '21.40 <br /> FIRE ALARM? 0 YES laNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: c4,E c iU1e 8 pe { 80Ria <br /> • <br /> CONTACTINFORMATI ON. <br /> OWNER NAME: /�,vyte,rn 4110,-7.4. it 0 ' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: 99 STREET (::::).FC)0/ (to-7c- <br /> CRY <br /> o-7c- pr , <br /> CITY jr�-� W)STATE fir-vZIP Z.24CJ <br /> OWNER PHONE: -,-25 _ e7 2.+?t---1Cj OWNER EMAIL: .. . . .. .. . .. . ... . . . .. . _ <br /> , _.,. ,. <br /> CONTRACTOR NAME: Ow 2 UV( <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER v `0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> , CONTACT EMAIL: <br /> AGREEMENT.-T hereby certify that I 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! <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• S <br /> PERMIT# <br /> 77._ <br /> .//i ‘..,,,..:,,,,,_,.... - ,... 0 E t,t) ( 1 o 41-a)/ <br /> Owner/Authorized ent Signe ure Date (Revised 10/12/2015) <br />