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0 <br /> ILECTRICAL PERMIT APPLICATION <br /> Ev CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> E <br /> PROJECT ADDRESS: 3©s 5jF file 'n All toty <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: (rO .QD <br /> NUMBER OF DEVICES (if low voltage): 7 <br /> FIRE ALARM? ❑YES Kt NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: JO c in Zv►C'X <br /> CONTACT INFORMATION <br /> OWNER NAME: C fie ILC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Inn VCa6-\) <br /> CITY U "o ( STATE ZIP 7166 <br /> OWNER PHONE: �+ OWNER EMAIL: <br /> CONTRACTOR NAME: CF QCd{i Gtfj 111 <br /> CONTRACTOR ADDRESS: STREET t7. Bm 3ZO <br /> CIN �r Ioock STATE ZIP 8()&3 <br /> CONTRACTOR PHONE: ((.QN�,Zu to CONTRACTOR EMAIL: 'v <br /> CONTRACTOR LIC.#(REQLARED): C ,IA L Q41 S3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)6Sy 7 <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: q-7!5-8Z " tZ53 <br /> �Tue , od l er_ CONTACT EMAIL: C�r2 k <br /> AGREEMENT. T 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 <br /> type of won<will be completed whether specified heroin 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 lam 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 /> FEE <br /> U. <br /> PERMIT <br /> PERMIT# <br /> n!2.-63-16 E �J <br /> OwnW/Autyff¢ d Agent Signature Date (Revised 10/12/2015) <br />