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ELECTRICAL PERMIT APPLICATION <br /> midgi <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8310 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT.SITEINFOR.MATION <br /> PROJECT ADDRESS: a <br /> orBUILDING AREA(i€res danflal, new:3no}if:. on, -amod?i,or additionS'r <br /> '. � '� <br /> ---- <br /> BUILDING TYPE: ScTA 1 <br /> 7 =, 3-72- ATTACH----"D; _ . 0D°'":---K ;LtULTI- r`,t�1f13 Y-/#OF UNITS; <br /> ®C,OiatMcRUW- <br /> USE OF BUILDING: <br /> LECTRIC.,L''APPLjC T1ON4.0 ORMA' lO <br /> CONTRACT PRICE OF WORK: $; C co <br /> NUMBER OF DEVICES (if low volt;.e : <br /> FIRE ALARM? ❑YESNO <br /> ASSOCIATED BUILDING PERMIT# if a.plicable'- <br /> DESCRIPTION_OE.W.n K:_......__A -. 10 6 — Art,40. .0--- .:-. <br /> 0 00 <br /> ' 3CONTA 1z I F,ORMA`C1ON <br /> "`' r '444.-' A) A " TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS_ ;TaE_T aa"6A 0 <br /> J i{ �. <br /> :,11Y ... gg2+o <br /> .:_..� r �r� � �nt.#� Sea;... Er <br /> OWNER PHONE: 2O( 2,11 45X2 I.G. OWNER EMAIL: <br /> CDNTRA:TOR NAME: Cryi v -a.„ I t (4' r <br /> CDNTRACTOR ADDRESS: ,j I't 15 6 +; :.L,,kuc ,{ . <br /> CITY ��, 'Ai �^_' STATE `YY�'y1 qr 2 <br /> ZIP 2{, ' <br /> CONTRACTOR PHONE: *, *meq O , * CONTRACTOR EMAIL: • "may I <br /> _aci TR-AeT�SEt" :ti(REQutRED)i �11I 411 ii; it , Y17 <br /> CITY OF EVERETT BUSINESS LIC,#(REQUIRED: av <br /> PRIMARY CONTACT: '�^ Vlt� <br /> ❑OWNER CONTRACTOR d OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1--- S a59 <br /> 1 f,10,10 DLT-co <br /> le deb pi' <br /> - Y t'e+ 1 al <br /> AGREEMENT.t hereby certify that I have read and exemined 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 euthortty to violate or cancel the provisions of any other state or <br /> focal 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 1 <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> veb�� PERMIT# <br /> E lcglc — 09 S <br /> '✓•risrtAuthorized Agent Signature <br /> Cate <br /> (Revised 9/23/2016) <br />