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"IP ELECTRICAL PERMIT Pik3LICATION <br /> Niiiwi CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 j (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION` <br /> PROJECT ADDRESS: /J / /174/e.W. J, j/ ,7vt/ Die <br /> BUILDING AREA(if residential,new construction, remodel,or addition) o?0 0 SF ' <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: .-04 O <br /> ELECTRICAL APPLICATION INFORMATION <br /> 00 <br /> CONTRACT PRICE OF WORK:$ 3000. <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /21,)i.) ,v.e-- I,/g.er-,a A.c/G�c- f J5 se. 4) O <br /> FA-444 DAG E". <br /> CONTACT INFORMATION <br /> OWNER NAME: j/„c./ "'"),41/4-7-c/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /jZ/ .041,4,02---,,6- rte...J Dot. !�+ <br /> CITY 4//0ie.c.� STATE /ZIP eeel/ <br /> OWNER PHONE: C.w(v •Y 7/EP-/c 0 9 OWNER EMAIL: /e/� i//f,✓ 0 g d c 1 ( . G c9,i- <br /> CONTRACTOR NAME: Cil A St\ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> . .�z, nwK.. .::. :_ _...�..�z,. ...:w._...� .a�_...,. .w:� ... �.. ..:,�: ,._.,..,,. H.v.,,. ..._ ..r., mx ...... .- n. >_.,w.: _ _—.... , x,a. ...,..n,,..,,._.w_ <br /> PRIMARY CONTACT: \OWNER 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 /> PERMIT# <br /> 411111r 4:/, <br /> i E 1,(2 0(.0 - r-6L-( <br /> Ow er uthorized Agent Signature Date (Revised 10/12/2015) <br />