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=. 11_,ECTRIICAL PERMIT APPLQCA11O <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 ADDRESS: 3(9191 0 4 e <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: E COMMERCIAL <br /> USE OF BUILDING: 4. ( y \ Qt. 7"c' D " €"S <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2_6 0 o 0 0 , CSO <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? DYES 0 NO v,'0 IPS'^-1 '1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • DESCRIPTION OF WORK: 4 1 TI oP Cr)//r)TY Q 'er .4 L-,') fry <br /> .... .. . ..:.. . . . . . .. : <br /> . .,.:.. .. _.. .. :- : _ .. ... ..-:_: :..- :,-.- ;�; .: �®N C`d'_ANFOttIV1ATION,.;.: .... . . .. ... . ..... <br /> OWNER NAME: _5,e) D 1.-‘0,11)*S C-, COy TENANT NAME(If Commercial): L <br /> OWNER MAILING ADDRESS: STREET <br /> COY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: GL lc Ce A'S-7--A I/C 7-.1_9✓✓ L2-.0 <br /> CONTRACTOR ADDRESS: STREET 10dn',L .� S_ <br /> CITY ]J(f'l-j(�R 3)V- 1 STATE 1'.714- IP '58'213 <br /> CONTRACTOR PHONE: —��3 CONTRACTOR EMAIL: CG4C'2✓v5) ve T J - <br /> CONTRACTOR LiC.CREQUIRED):CGK Ch(e)'i b L CITY OF EVERETT BUSINESS LIC.#(7 EQ D t <br /> PRIMARY CONTACT: 0 OWNER Er CONTRACTOR 0 OTHER(Please Specify) I __ <br /> CONTACT NAME: CONTACT PHONE: <br /> 3bD 3S'`�- 2s�3 <br /> pS kt'/(z4'/ CONTACT EMAIL: CLk-Co,v, c r, 64'I4-,(J-CC7 <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 ordina erning this <br /> type 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.r <br /> local law regulating construction or the performance of construction. That tam 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 /> FEE <br /> 06 <br /> _ <br /> PERMIT# <br /> s--3)-20j e F 5-? <br /> Owner/Authorized Agent Signature Date (Revised 90/9212095) <br />