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477 EgiECTRICAL PERMIT APP.ICATION <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: no ,rorN <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: o SFR-DETACHED o SFR-ATTACHED o DUPLEX o MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: 13-1/4l `r ast1.6 5 \) CeA - <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): I <br /> FIRE ALARM? 'AYES o NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: lf\ kCL CLh O \ O-Q- A-CS " O (O IOVI,QVLIt� <br /> 1n PCC'. (cX fv\ <br /> CONTACT INFORMATION 11 I r lstys <br /> OWNER NAME: TENANT NAME(If Commercial):WkOV XO)0Q, kc <br /> OWNER MAILING ADDRESS: STREET'- -„«® �1� � <br /> CITY `V c Cl.`AQ p/6a-t€ STATE ZIP <br /> OWNER PHONE:k a5 \5 0-1L4 1 OWNER EMAIL: <br /> CONTRACTOR NAME:GJO IV-- S r V\ ? tc uY1A--`( <br /> CONTRACTOR ADDRESS: STREET ( 1//L��A'S ii It Si— ,i;4-, �//}/✓�� // /y� <br /> CITY < lJ" \"e_ STATE WA- ZIP C l3 ` 1 <br /> CONTRACTOR PHONE:a [Q -D-(0c5 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):610k„cSiFj ?:)?: ICITY OF EVERETT BUSINESS, LIC.#(REQUIRED) �43 <br /> PRIMARY CONTACT: o OWNER 0 CONTRACTOR OTHER(Please Specify) �lC LV� <br /> CONTACT NAME5abJ ILC.w CONTACT PHONE: ( L5 ext3 3(o <br /> CONTACT EMAIL:.\(er/ } 0 9 ° v'6, V)S COr fl-v' rC �►' 1 <br /> AGREEMENT:I 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 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/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 /> PERMIT# <br /> 1Q)le Eig) bi-OLF-D <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />