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I <br /> 000000. <br /> 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 I www.everettwa.gov/permits <br /> :: . ..-,...' .,.. . 4 ‘7,''''":<'5P-i''-'!---- <br /> - ..' �" Q�IECT SATE INFO+'MATRON: ' �' <br /> PROJECT ADDRESS: I 2D Is, <br /> BUILDING AREA(if residential,new construction,remodel,or acditiop)` SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: eOMMERCIAL <br /> • <br /> USE OF BUILDING: <br /> _4,g KK . ELEC'T'RICAL AilmicATION I+IFORMATi4N <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low volIattp)t. - <br /> FIRE ALARM? 0 YES ISNO <br /> \ASSOCIATED BUILDING PERMIT#Sy applicable): <br /> DESCRIPTION OF WORK: i 4,-Nteccxylricaon -1.r.- Ai <br /> t ins'+ ker - UC �... <br /> (Ak t.f - t�2 0( 0 0 <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commerclat):' ' ..: <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 4,4plirDA 0,CCAYI(.„,..., <br /> CONTRACTOR ADDRESS: STREETIblagY" *.'icyci <br /> # IP, lel <br /> CITY ��i.� le- _. _ STATE 1� _.ZIP <br /> CONTRACTOR PHONE:3(„FQI O CONTRACTOR EMAIL: V°I `. IA Tec..• <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIR D):D39 toj <br /> PRIMARY CONTACT: O OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> " C.QSg ODI <br /> �`t'tnr CONTACT- AIL: t3 hwILI CLC. <br /> • OYY1 <br /> AGREEMENT,'1 ha-"•y 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 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 296200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 3 " \e) E t t - ( OZ <br /> • (ter • thorized Agen ;nature Date (Revised 9/23/2016) <br />