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"op ELECTRICAL PERMIT APPLICATION <br /> 1111111 - - - CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMAT7 <br /> PROJECT ADDRESS: Z3 Z S 74 11,-- •-±., 5 <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 7 50 SF <br /> BUILDING TYPE: lig SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: CG'S I d VL-2C. _..— <br /> . <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 6, SOO ,2---pp(ox i vr.�--t-- _.._.- <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? _RYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): -(b 0 9 — 00/ <br /> DESCRIPTION OF WORK: giait.if j'-. t,_)'1. I` t c,J('LQ ho 1- <br /> • <br /> //jj. CONTACT INFORMATION:. .. : <br /> OWNER NAME: Rte./Act rd( I co I. - r P kce14-TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET "Pp Box-}f� 54227 <br /> CITY E-r`e cell" STATE (r...) \ ZIP 93 Zo6 <br /> OWNER PHONE: �4z )'3764-4 f ( OWNER EMAIL: -k- S I 5 2-2 Cd(IAC -f s 1/1:-e <br /> CONTRACTOR NAME: 0 w ti- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> W <br /> PRIMARY CONTACT: TOWNER 0 CONTRACTOR v 0 OTHER(Please Specify) c <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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> t00 <br /> PERMIT# <br /> U (- t.V /(. t7 E t9- < < " �-� <br /> Owner/Authorized Agent Signature D t�e (Revised 10/12/2015) <br />