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4k-7"r ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PR©JECT.SITE,IAIFO,FIAVMATION <br /> PROJECT ADDRESS: 2 A Q Lt - ,j- 5 <br /> BUILDING AREA(If residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: 'CO/SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATIONPINFORM, "ION <br /> CONTRACT PRICE OF WORK: $ ,c°' <br /> NUMBER OF DEVICES(if low voltaue <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable), <br /> .DE IPTIML OF WORK:.. _ <br /> -`"C. * .. .A.±5 fes. ' — Yip <br /> C4t IM;OftMAY <br /> 1+I T'-AION <br /> OWNER NAME: 1.-Ntk,ep. 0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STItEET9-40 <br /> { 0:2 ti/} �+�1J1( <br /> CfiY ` t.E ti.ri ( ` STATE \A0I ZIP 0( 8 01 <br /> OWNER PHONE +M5 0 OWNER EMAIL: <br /> CONTRACTOR NAME: VAY-4.A..4 1 <br /> CONTRACTOR ADDRESS: STREET tJ �p I rO to <br /> CITY 6.- �+•� STATE \ti"S- ZIP 20 I <br /> CONTRACTOR PHONE: 1- 5 Q5I O 'CONTRACTOR EMAIL: d>? i e a Ch' ktt <br /> -CONTRACTOR -#okEauiR��>: }rt,, �-ia't-� �'q`�t'r <br /> T► 7-1 ''t _ CITY OF EVERETT BUSINESS LIC.#(REauIREro: <br /> PRIMARY CONTACT: 0 OWNER r,tr: CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lf 9 <br /> Vsiotie CONTACT EMAIL: w.(tr�y,t nru; <br /> AGREEMENT:I hereby certify that I have read and examined(his application and know the same and cont. All provisions,oflaws endordinances 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 /> � . <br /> Alb <br /> a - ,- E 1(%O8-1 j) <br /> Owner/Authorized Agent SIgneture V <br /> Cate (Revised 9/23/2016) <br />