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,dP E 7.7.CTRICAL PERMIT APF CATION <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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 0, / c� 3 J U(o 1 �f. S. c c V v"e- . C-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: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): //0., <br /> FIRE ALARM? 0 YES Il -NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: c ; 5 -yy , + ) n1S fU <br /> 11 - C, <br /> - cam Coio&Der OAs <br /> E {e rvcl Eco C' r u 4- (=•7o CrA ) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��(� �F ,4 .e n) (j TENANT NAME/ (If Commercial): <br /> o( �=\ <br /> OWNER MAILING ADDRESS: STREET /O !C `G -t G I �r �/ <br /> CITY E v P —1P STATE � , j—} ZIP 96 Ci <br /> OWNER PHONE: ';r jC)— jC) OWNER EMAIL: <br /> CONTRACTOR NAME: /•-.1 r-; EL/ p C Ir�� G <br /> CONTRACTOR ADDRESS: STREET /mj(-) 1.5 - ��(n �h /S J L D? 5'-t /4• • <br /> / <br /> CITY Ly 1 A")��p�-�( � STATE C 1A.. ZIP 980.3([› <br /> CONTRACTOR PHONE: ''y35 7 L- 70cc) CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): MRF-IFF lt-;ICITY OF EVERETT BUSINESS LIC.#(REQUIRED)P5/5340 <br /> PRIMARY CONTACT: CI 'OWNER `CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT EcNAMEI CONTACT PHONE: .far — 77 Lf — 70 U <br /> /-<c) S �, © � � c€ <br /> c <br /> i- CONTACT EMAIL: <br /> AGREEMENT."I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of talks sand ordinances governing this type rr';L, <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 /> \K7 <br /> PERMI # <br /> /y - E \ () OS <br /> Owner/Authorize gent Si ture /Dat (Revised 9/23/2016) <br />