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4-77- I LECTRICAL 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 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> /PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: `7"!Z 1Z At-ft y' <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: ,COMMERCIAL <br /> USE OF BUILDING: YC,UV `)QVC <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2 f 7-40, <br /> NUMBER OF DEVICES (if low voltage): - <br /> FIRE ALARM? 0 YES 14NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): LL <br /> DESCRIPTION OF WORK: (4 ) 2C)\/ 2OA Ozo- for- re/OC t ,.c < I.-(" (1 t L. �5tal KG LS <br /> CONTACT INFORMATION <br /> OWNER NAME: c.v. /joy TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 41 25s;)- cutc, c,, <br /> CITY .�(,� (A/A qy' ZD STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ` tet ,G- C--dC;--v(- <br /> CONTRACTOR ADDRESS: STREET 70 CiU7 22O 11-1. r <br /> CITY vit- STATErZI �� / <br /> CONTRACTOR PHONE: J .b(C7 1 • 7.55(,, CONTRACTOR EMAIL:61`t�,I,(alt •tai,)7 O 4� C (( L {"UGC L.OYV) <br /> CONTRACTOR LIC.#(REQUIRED):S MC,10 f C CITY OF EVERETT BUSINESS LIC.#(REQUIRED): V 3 37 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /y CONTACT PHONE: 253 r �i��}Z �j,`}'&' <br /> lUL �I� Lo I`'�7i i CONTACT EMAIL:61110,k0. ��L� ( ":rotj.,-(CTZ; 1/ L{+VVI <br /> AGREEMENT:1 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 typo <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 1 <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 1WV_ Jii14) <br /> c El (2" 02 <br /> Owner/Author z d Agent Signature Date (Revised 9123/2016) <br />