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ELECTRICAL 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECTSTE1NFO AT <br /> ION. <br /> a 1 ,•.,:i€:',-,:'.. <br /> PROJECT ADDRESS: 2// (I«4. 74(7 ;. . <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: <' rKj14✓0 .--. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ W (/ *) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES /InO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> Dig (9 ,L 4_r Xoe51`C` PZ-ail <br /> g‘----/. ,a4 4,-42- .S.'- g AA.r /1.1 /-1$82W10',4,-/ <br /> `CONTACT;INFORMATION , ,. <br /> OWNER NAME: aw -‘1.--- TENANT NAME(If C.mmercial): S s� _ j-- <br /> OWNER MAILING ADDRESS: STREET 4--,e .?,,,,��C y�y/ <br /> CITY _. /44,,K7, -, STATE Ir ACr ZIP 997c-A <br /> OWNER PHONE: / -tf OWNER EMAIL:IL� G `� GA ' W6::%�`� <br /> CONTRACTOR NAME: Roke— e... . /�`G+/�� (-iii OW 4)�* <br /> CONTRACTOR ADDRESS:/ STREET Fzv �42--- <br /> CTY i1.11i7 STATE E ZIP 9e2 7X---' <br /> CONTRACTOR PHONE: /02cl�r- f- CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> ..,..,. , ....a, <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CON T NAM : CONTACT PHONE: <br /> /��7- i2j� - �i /� �'' <br /> ."-4: _--- CONTACT EMAIL:tf ' 4 ,t / /G li"/ G(�i��/j <br /> AGREEMENT*I 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 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,/ice " 11' t/////7 E7 `'t,O to <br /> � 6 r <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />