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(41:77 ELECTRICAL PERMIT APPLICATION <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 F www.everettwa.gov/permits <br /> PROJECT:SITEINFORMATION .. <br /> PROJECT ADDRESS: 1 4 i f?1" Q 1 5 -7 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 31 SF <br /> BUILDING TYPE: FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: g.495 etvp „ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: la.t)Y1r\tl !1_IJu) A((Ai( C1- Alir(/Ou1a4m-67[.1 -O ftc <br /> CONTACT INFORMATION <br /> OWNER NAME:H Oh(a MnA d kYV A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I`i 13'k PI sr, <br /> CmrIttlf.eAt STATE IA) ZIP Cig (),q" <br /> OWNER PHONE: 1-1,2S-- 7j-'f -QUirj` . OWNER EMAIL: <br /> CONTRACTOR NAME: G E S P,Q Ck+n G} <br /> CONTRACTOR ADDRESS: STREET 3LiQ_tC tr 9 J /�4 <br /> CITY t�.W2kta- STATE ZIP x$,20! <br /> CONTRACTOR PHONE: '4 ( 1O-14,p.95-1 CONTRACTOR EMAIL:S(1/6.02(h e M4415 <br /> CONTRACTOR LIC.#(REQUIRED):(-iS- j*( 12.,16, CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 101 to <br /> PRIMARY CONTACT: 0 OWNER "ErGONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT �( <br /> NAME: CONTACT PHONE: 2 r,..co n,L4aEr-t <br /> Sara ra 4ffyy l( fr'1 d CONTACT EMAIL: -)fa(u1 c P+4.14 fi <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and4rrect. All provisio7fs of laws and ordinances governing this type <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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 4cia441 <br /> Owner/Au zecrAge` •nature Date (Revised 9/23/2096) <br />