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4-17- ECTRICAL PERMIT AF i LICATION <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 /> PROJECT ADDRESS: '1(0oo $Ufl on) b2 . <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: 1;XPLog42. N„oDL5t. SG)toe i.. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z3oo <br /> NUMBER OF DEVICES (if low voltage): )O <br /> FIRE ALARM? YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1,Vs?ALA- c_-A9`/nom Ana, 1724r- op02 AL-4421^-N 94- c S_ <br /> G,/24 A GA p r',T 13y Pa4.2P12-14 i A2-N1 V4r..rvoO& . <br /> CONTACT INFORMATION <br /> OWNER NAME: MJC-l(.1`cv Sc-1 1--?>!57 TENANT NAME(If Commercial): £ -o,-jt1 _ Yh,r.pL. A-Hoc)L <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 9 4 N Ftill. An)O Str-Lk..,2 119 L-LC <br /> CONTRACTOR ADDRESS: STREET 10 Goy. 3"7) <br /> CITY (xRA.1 t.)&0- r•.) STATE t'vA <br /> CONTRACTOR PHONE: 1125- 24'y /Epic- CONTRACTOR EMAIL:SE.FF e.g./kJ H Pi .C_O <br /> CONTRACTOR LIC.#(REQUIRED): $H F 1 .H Ir 554 Z)LI.J CITY OF EVERETT BUSINESS LIC.k(REQUIRED):oc51 7 <br /> PRIMARY CONTACT: 0 OWNER 1g CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42,4" z ti <br /> CONTACT EMAIL: S��r � }�'r ,r . <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 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 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 /> FEE <br /> PERMIT# <br /> 4°°9 6/81 ► E (s cc& -000 S <br /> Owner orized Agent Signat i Date (Revised 10/12/2015) <br />