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� ELECTRICAL PERMIT APPLICATION <br /> - <br /> fir'a - - 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 INFORMATION <br /> PROJECT ADDRESS:A(._9(- k. )-\*V1. <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: kf COMMERCIAL <br /> USE OF BUILDING: ,��() \\.5,\,/`<"\C <br /> ELECTRICAL.APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 6 °"(-) <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? OYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: M(�, G (A) < Oc <br /> -Lo <br /> CONTACT INFORMATION-_ <br /> ' <br /> OWNER NAME:-jv fc---\-- A "L <br /> i' t.1 TENANT NAME(If Commercial)` �(�Jje� <br /> OWNER MAILING ADDRESS: STREET r>.-)m `. jJL"l <br /> CITY-k-5)v'e)( STATE ON ZIP CAt <br /> OWNER PHONE:( 31?-)--\l00—k OWNER EMAIL: <br /> CONTRACTOR NAME: (`u "4->Pf L A(l ktA 'AjtX'n'A <br /> CONTRACTOR ADDRESS: STREET k1i-V ) <br /> CITY teG``'r-WL, STATE \AN. <br /> ZIP cR,1 t, <br /> CONTRACTOR PHONE .( C.):(5)Q1' _ L (P CONTRACTOR EMAIL:(1S&CCtik3J4i\tAZ3u(?r,Y( il(`ja_/- Dariij.CJt <br /> CONTRACTOR LIC.#(REQUIRED):l-0Ac�}55,„ ,�J " , CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 3.334 .03 <br /> PRIMARY CONTACT: 0 OWNER i' CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: • u2.-/ - • to <br /> %Q1 >P 0Y lii,r CONTACT EMAIL:( "yfC1U�.I v\tv\ (()m�`�c ill fl,1frl 116414.0 rYY1 <br /> T. <br /> AGREEMEN 'I hereby certify at e read and examined this application and know the same to be trueland'd � <br /> rrect. All prdGisions 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 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 /> PERMIT# a..,,s, <br /> Da, u tic A c_1e 1 Is <br /> Owner/Authorizelgent gnature Date ( evised 9/23/2016) <br />