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4/E77 illt. 4040p. <br /> ECTRICAL PERMIT APRICATION 40,edk. <br /> CITY OF EVERETT PERMIT SERVICES <br /> V IT <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 /> wiif"•,. I�"�'iii � J 4s 'I;� w(i,` j �i i^�* P /� S �, 4 ■� ■ �'.,(4` i �"A ion r' F ill iy y y4` a Jrd r'�,T ti iili�,' ,� <br /> ,...,:�.ef ;:.L_ .w,p,, ,� �-.-- ,:�P ^� �.r�, .�:, .. *ttt T N:Ogik:l t0*th., x :Pl .'a '.?', �n` ,-�� I��C,' r.'' i 'arJ` F '1•... <br /> PROJECT ADDRESS: VAO\ In q+41 P ;ice <br /> BUILDING AREA(if residential, new construction, remodel,or addition) r..(�'j iC T Y r"WA SF <br /> BUILDING TYPE: FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ZM- ..' r G a,'"'#P a ELECTRICAL,ARP ,IC�ATIONi INFORMATION 'PrZ Tr„r 7, ��u�� <br /> CONTRACT PRICE OF WORK:$ 1 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#Acv7v <br /> (if a plicable): <br /> DESCRIPTION OF WORK: )i O1UCN 1e 5 hea— pxip <br /> `� i CONTACT, INFORMATION s <br /> OWNER NAME: \ t\l,V' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1-'-10 I q 74' .�( 3E <br /> '%' CITY VV[•rso STATE 6J3yYvYit ZIP�' S��OWNER PHONE: 117 0 (58l0 OWNER EMAIL: Z010).e .CONTRACTORNAME:�,IfQ �f6 <br /> � <br /> CONTRACTOR ADDRESS: STREET i • �j.-7001 sh y,t <br /> / • CITY L.-T-- STATE ZIP I <br /> 7,01-i-5 <br /> CONTRACTOR PHONE:1L71 I ---71-yet"( CONTRACTOR EMAIL: 1 r1�o Q b u k wkrood-OVt et,.60le <br /> CONTRACTOR LIC.#(REQUIRED):VL-(JEFFF}931 1(4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 52 1 qO <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> • C NTACT NAME: CONTACT PHONE: q � ' — --- 13 q <br /> Van,n1a Yl aGM� CONTACT EMAIL: '6 & to topra <br /> ► er <br /> AGREEMENT T hereby certify that 1 hav ead and kyamined 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 /> 4-1Fv°✓ <br /> (4, <br /> PERMIT# <br /> 1 /1/ //-7 E1 BO 1 -6O(D <br /> Owner , horize• 40•ignature Date (Revised 10/12/2015) <br />