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OLECTRICAL PERMIT AM_LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I (E) everetteps@everettwagov www.everettwa.gov/permits <br /> PROM&SITE INtORMATIO7,' <br /> PROJECT ADDRESS: gN000 Vr.€ \-\ Au; <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: 7..COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION - • <br /> CONTRACT PRICE OF WORK:$ \so) 000 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? DYES ZO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1.v,c4., \ot-kOn 11,1•4"‘J Cellv ialr 1).A <br /> /RI\ (A yy4-4/v.t.,ots <br /> - • - <br /> CONTACT INFORMATION • <br /> OWNER NAME: TENANT NAME(If Commercial):AvIty\ c) iv\s, <br /> OWNER MAILING ADDRESS: STREET D.(20 0 \- et4.'\ \ A-t)c_ <br /> cm, 2.,}_k STATE A-4- <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Co,\\ SS4e-iwiS 'I )-C_ <br /> CONTRACTOR ADDRESS: STREET gAl- ZAN e kik tA.,,,3 V\1. Ci 6 <br /> CITY %Q v_d.QSTATE kAlt, ZIP bou <br /> CONTRACTOR PHONE:DOG tl° 01-0 CONTRACTOR EMAIL: .1,vIck nc,\\ rv..SS/1.-4,^^"S• <br /> 41tONTRACTOR LIC.#(REQUIRED): ),L1 c"‘ a\ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 4./Vie CD, <br /> PRIMARY CONTACT: 0 OWNER "4,,CONTRACTOR 1:1 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 5,06— <br /> 101/K Ge-1\\\49)./N CONTACT EMAIL: <br /> AG EMENT:Thereby certi8/that I have read and examined this application and know the same to be true and cortet. All provisions of laws and ordinances governing 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 or <br /> local law regulating construction or the performance of construction. That/am 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 296.20n WAC. <br /> City of Everett Official Use Only <br /> FEED <br /> , <br /> • <br /> PERMIT# <br /> VaL)) ) ,?) E i So -177 <br /> Owner/Authorized Agent Signature ate (Revised 10/12/2015) <br />