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SPfrysv---,4 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everettepseeverettwa.gov I www.everettwa.gov/permits <br /> =ti <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS: 30°1 f.,() % "L? �/ L [` ✓ 0 �1`tom 48 ' . /o'C+S- <br /> BUILDING AREA(if residential,new construction,remodel,or addition).- $F <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 1 DUPLEX ❑MULTI-FAMILY-#OF UNITS: al COMMERCIAL <br /> USE OF BUILDING: 62F-F-72( <br /> 'ELECTRICAL:APPLICATION INFORMATION . M <br /> CONTRACT PRICE OF WORK: $ (2 ci/ 7PC,? L--c) (.11.724.0-7----.0-r=- 1.t 1 J F�- <br /> NUMBER OF DEVICES if low voltage : p <br /> FIRE ALARM? 0 YES p-NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): re27Z)E—/ „ XN., (7,C/C 11'er)(, <br /> DESCRIPTION OF WORK: <br /> Z-1,25-7-y)-6— pz' /h) . 1/)11 <br /> `f 0 G c PM--= �' c /PA') (2-) J'o /' 7.)(S r1;,4.7/5 ?.' 2 <br /> )06, tYY4'7 /Q7'15-5- C 016-7)1 ') <br /> CONTACT INFORMATION <br /> OWNER NAME: 'O TENANT NAME(If Commercial): 0a/,A-y •--- <br /> OWNER MAILING ADDRESS: STREET'3007) j j (j5,i''V ?t9Th l'lLt2,/\4 470" ', j <br /> ciTy STATE (Ai ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: / LYE— 5 / i27 <br /> CONTRACTOR ADDRESS: STREET 3J5 35-)Li-71 >'/�i "� `�/ y / T' / �!{ <br /> CITU 7't,/K(4115:4--- STATEV....0" ZIP rt /66, <br /> CONTRACTOR PHONE: 10, 7 57 pS/ 0 CONTRACTOR EMAIL: 1'Z�' ,A2-!f(/ e -f- Sk}r,,..L/.,L Ce)4-2 <br /> CONTRACTOR LIC.#(REQUIRED):& uE.., 5„:1- C/3 Z1/3'? CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (YR/1 o <br /> PRIMARY CONTACT: ❑OWNER ygpONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:,, ) CONTACT EMAIL: ( /L.C.-v 2f,u( I _ (J kY �•--,.z G �'�' <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 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 /> PERMIT# <br /> �. ( c 207,6 E taOi -O ( <br /> . .w PAu orize•Agent Sign. ure Date (Revised 10/12/2015) <br /> 6/5��' <br />