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OjE77 ELECTRICAL PERMIT AP?LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> *ROJECT'SITE INFORMATION <br /> PROJECT ADDRESS: 3O M&,p`e Sire <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: :e -41 <br /> ELECTRICALAPLICON INFRMATION==4, <br /> .. : <br /> CONTRACT <br /> PRICE OF WORK: $ (0,00x7. <br /> NUMBER OF DEVICES(if low voltage): 6,JO <br /> FIRE ALARM? EYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` (� <br /> DESCRIPTI N OF WORK: liporaA.,-e_ b� �f,L a�a,r vv. <br /> r Iev� u�s r'c. d -r W v\ . ���n e 1 LIQ 8t L4 Cl <br /> CONTACT INFORMATION <br /> OWNER NAME: 'r,t,r \./ ) �-� TENANT NAME(If Commercial): ('Dtt j°j 1V <br /> OWNER MAILING ADDRESS: STREET ]70 O � / J 2-7 " �- -+- <br /> cry `�.- V STATE A-- ZIP 41(6©S---7 <br /> OWNER PHONE: �(-ttS - J Z-7 OWNER EMAIL: <br /> �1 �� ��.. a� sem, k/p,. 6 r''v�U--- <br /> CONTRACTOR NAME: ('_ t v6,i(\ <br /> CONTRACTOR ADDRESS: 4 {-.STREET \rA l k(,\c k1)& 5 <br /> CnY ��)(�,�(>Y`� STATE \...A3�� ZIP /C‘QS <br /> CONTRACTOR PHONE: LISS S5 I-SICI S CONTRACTOR EMAIL: (. ,t j ty\. e y ® to nV.e41 C piv‘ <br /> CONTRACTOR LIC.#(REQUIRED): Lc)luv MIL g LI 6 A CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 4 26.4 a <br /> PRIMARY CONTACT: 0 OWNER iEONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 is- <br /> fai CONTACT EMAIL: �� iti)C,c)(‘t1ev ✓l\. Ccjwt <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. Al 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E I <br /> rlAuthorized nature Date (Revised 9/23/2016) <br />