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°1111.41 <br /> PLECTRICAL PERMIT AILICATION <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 SITE INFORMATION <br /> ca <br /> pp <br /> PROJECT ADDRESS: 300-2) 1,J U15 n c a• 4O ' " C‘YACI 6v5 (,o1 uv w +1 12, <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: >CCOMMERCIAL <br /> USE OF BUILDING: (A <br /> ELECTRICAL:APPLICAT1ON;INFORMATION <br /> CONTRACT PRICE OF WORK: $ (o0f V-77( , 3� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? o YES '( NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: y1154-QUU 1 AX15 j434 5(cecr1 sN 71101L)RS <br /> (� / CONTACT INFORMATION <br /> OWNER NAME: 1-)AL. L3a2 A(\c Cor pcAn / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f( <br /> CITY STATE ZIP <br /> OWNER PHONE: �O`WNER EMAIL: <br /> CONTRACTOR NAME: C�'1+sC�I �nrrrv\i LJ LY 1 G, <br /> CONTRACTOR ADDRESS: STREET 2 Q2j ) J <br /> CITY :‘,\•1 Cfa•kt STATE \/ <br /> OIA ZIP 9 i20.1 <br /> CONTRACTOR PHONE: 42.S e 5)3-cl Oi ll CONTRACTOR EMAIL: CQV1+0.(* (J I i ). (,O <br /> CONTRACTOR LIC.#(REQUIRED): l_OTR.D'. J rn CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C)5" -S421,7 <br /> PRIMARY CONTACT: 0 OWNER )( CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z0(,..,--%) �-(.t S01-( <br /> G?(7 n cCC)0Q I I CONTACT EMAIL: 044'1n�M� ( ;AL1 C�•,� <br /> AGREEMENT:I hereby certify that 1 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/am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 5//5 E I 61 05-- CYC <br /> Owner/Authorized Agent Signature Date (Revised 923/2016) <br />