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477 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential.new construction.remodel.or addition) y' (Y1 atilt,I SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ) COMMERCIAL <br /> USE OF BUILDING: Pot--4-able.,O blCs i` S COOI <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ' S-/c a 'o*ea ‘-1 .....- <br /> NUMBER OF DEVICES(if low voltage): fl 00e <br /> FIRE ALARM? 0 YES ) NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Bu 1 a k r Qe-iC)nn *- I Cl p r©Cess <br /> DESCRIPTION OF WORK: al l‘Cj F- - -kO o c ID rn s 1 -On fee_ aea j Co*c_d <br /> 6 ccu'\i-S -Qcc 3 \no+ uva+er ine_a e_csI and ,cep lac_i irt3 16 <br /> fcce;7+-ca cl s . <br /> ` CONTACT INFORMATION <br /> OWNER NAME: �O 1 feo ScV)00\ 013t60--TENANT NAME(If Commercial): S Q MC- <br /> OWNER MAILING ADDRESS: STREET <br /> 7�,CA4 d\ k(1U`CQKI D c I\ie_ <br /> cm Lv f -c STATE WA ZIP 9 Tco a41 <br /> OWNER PHONE: (-{as-3 ScI all7L OWNER EMAIL: W e�J'(Y�gs-ver iYlo v-1 V1/4-ex, u)wine}- 'etc - <br /> CONTRACTOR NAME: ; ,`lC V1Q \ Do bl CU1 e�c � DO�� \e`'G'�C't C Li--C <br /> CONTRACTOR ADDRESS: STREET <br /> 1S8 A S'E.-- <br /> CITY S no\ 1l't Y 1 J l STATE U3 A ZIP 1'aCI o <br /> CONTRACTOR PHONE: L43_L4 19-- OC 1 1 CONTRACTOR EMAIL: Gkc��c�e-1 e.c-it'l c-l k C e3 mai I ‘ con, <br /> CONTRACTOR LIC.#(REQUIRED): 1)0EE 1.-8 a a 3 G CITY OF EVERETT BUSINESS LIC.#(REQUIRED):53 L 37 <br /> : ❑OWNER $ ONTRACTOR ❑OTHER(Please SpeciPRIMARY CONTACTfy) <br /> CONTACT NAME: (� CONTACT PHONE: (.4 S - .3 g-7 - -7 a &..�S <br /> Le•c Q 1 3 c1S C h CONTACT EMAIL: -� Co f\S"'-'3 C�.- e(3 r \e,(''C.U'M <br /> AGREEMENT_I hereby certify that I have read and examined this application and know the same to be true and correct. Ali 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 1827 RCW and 296200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> / - , E ( 00'/-6/7 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> If <br />