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4ILECTRICAL PERI �T APPLICATION <br /> N <br /> ��I✓�-,- 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 www.everettwa.gov/permits <br /> I''a�Ji cT Su`i'IE. iIM F#0/.1.41101 :r; <br /> PROJECT ADDRESS: ZO e ( jCK FE LL -R— <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: RES,DE,/1C <br /> • II00R3!!MATION . . <br /> CONTRACT PRICE OF WORK:$ .5 C�. <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 12110 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Je2/Ar-8. 5"Eie /C2. 3-L E l e t tT(O►3 <br /> seRL) L� j� ue u,N�` . 'To a ��' t <br /> CONTACT INFORMATION <br /> OWNER NAME: <br /> C�'44L.GS� �f 71/UG EA_ TENANT <br /> �NAME(If Commercial): ---- <br /> OWNER MAILING ADDRESS: sTREEr 55 tip 6eS-t.., �� ,p q <br /> C. <br /> cn' � V( A-.STATE ZIP .k I <br /> OWNER PHONE: 4-Z� j 2 l5r3 OWNER EMAIL: % ' <br /> CONTRACTOR NAME: -Z--F <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> Q�ysGi�", <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 lam 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 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> Loo <br /> PERMIT# <br /> ..� 1 El 'ZOS RI <br /> Owner/Authorized Agent Signature I ; Date (Revised 10/9212075) <br />