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"illifr fLECTRICAL PERMIT AJPLICATION <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.gov I www.everettwa.gov/permits <br /> PR 1 jEOT:SITE INFORM TI®I _ . <br /> PROJECT ADDRESS: �3 l OI- is-f i u7' 54. <br /> 'BUILDING AREA(if residential,new construction,remodel, or addition) oICZ$() SF ' <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> - i <br /> ELECTRICAL APPLICAT1ON 1N F`ORMATION <br /> CONTRACT PRICE OF WORK:$ Z.�CSC)• <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /i��d& cI i47Un� ,. ./.2..e_4'(, int 4 S-Q®eto <br /> -.5/14-1 Ak1/V 111/1- ifer-X Rftilti. ilefrl 073 <br /> . .. <br /> ' CONTACT INFORMATION . <br /> OWNER NAME: JQrt,f eft Rt.re� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sreser ?a8,�i� /2 SS- <br /> e" <br /> CIN 4 ( STATE (A.M- <br /> /,ZIP ? ' a �Q <br /> OWNER PHONE: �0(.1) . Cil 2. .1713— OWNER EMAIL: .7CpJ f e ce„'1 I(/ e_c,p✓i <br /> CONTRACTOR NAME: IF <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: (CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQU ED): CITY OF EVERETT B ESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ( OWNER " ~ <br /> C1 CONTRACTOR 0 OTHER(Please Specify) �.�,..,.. MY ~_, ,.M_ :- ..,.. <br /> CONTACT NAME:__ —_, CONTACT(� CONTACT PHONE: / 19,2._ . 9 q q <br /> __ <br /> R <br /> {v L1 L fk___CONTACT EMAIL: J( 1.0.9 le((e_M t WE.e . NW' <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 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 100,. °b <br /> jiii.001 41' <br /> /4i f PERMIT# <br /> al <-4g 2 ( CE 1 (bOcth-- [ 40 <br /> Owner/Auth rlr: entt nature 1111111r. Date (Revised 10/1212015) <br /> / <br />