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ELECTRICAL PERMIT APPLICATION <br /> . s%IWCITY 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: ! 6CJ0 hCG 1^C' !A ; f—��1;19 Or<r /1/ J11CM . ��� '� ( <br /> BUILDING AREA(if residential, new construction, remodel,or addition) 17 9 2_ ++ SF <br /> BUILDING TYPE: 0 SFR-DETACHED © SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: C SSC, ( . c <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ S eco <br /> NUMBER OF DEVICES (if low voltage): / <br /> FIRE ALARM? DYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):_� // <br /> DESCRIPTION OF WORK: P/0 U t C� C c i (-4/c/a._�l Com' Cr7`i <br /> /`1 d)1 6 Ml C /c�Ss rho 6ti <br /> p� _ ( (city 4/(r 14`—`, r--, P<z) /ut S� x�'- 1 , c �tU/ 1 ecik,r;c}-rc�vtc� e, <br /> fIflfloc JOU <br /> / CONTACT INFORMATION <br /> OWNER NAME: /h1Ct 4, !j-e,c, .S '1cc'( di S i-rtc I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9 'Cl / 7Laro'i <br /> cnY STATE Lc 0-. CS;72,V <br /> OWNER PHONE: 9,2_r 3.-6 L/ OWNER EMAIL: -4-e <br /> k'/ieo t.iekte-' ecf.-1t <br /> CONTRACTOR NAME: MC tCs��ij �ytG� <br /> CONTRACTOR ADDRESS: STREET Pr%/ /Jg(�,. 9th?O (/ X��� <br /> CITY 45/kCi aMti��.e STATE �� ZIP CV �'/0 <br /> CONTRACTOR PHONE: W. <br /> c—,)9/ > P!� 'CONTRACTOR EMAIL: ft-K .fie:(4 it / 4 ; 4/Ie eef <br /> CONTRACTOR LIC.#(REQUIRED): Al C.GAVEL q // 1a. <br /> CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Os t1 <br /> PRIMARY CONTACT: ❑ OWNER lig—CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: o),S / L_CONTACT EMAIL: og? <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to true and connect.'M provisions of laws a 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 /> ,5c e <br /> City of Everbtt Officia Use Only <br /> PERMIT# <br /> 7/.7(t)// E 1OS O ,?' <br /> Owner/Autho ' e ent Signature Date (Revised 9/23/2016) <br />