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OLT ELECTRICAL PERMIT APPLIC�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> 1 Z 1 cu(,y../Air part. <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: g COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ I )000 ,00 <br /> NUMBER OF DEVICES (if low voltage): 2 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1nS\1 (I k'Vv() Ci )J <br /> ICONTACT INFORMATION <br /> OWNER NAME: `f rt/I'f,iii ' PatiL"r�laTENANT NAME(If Commercial): 6 I I/11 6 <br /> OWNER MAILING ADDRESS: STREET 3e0) f'1!j \1-� Ak MI <br /> CITY -_ STATE \Ai.13. ZIP 6?(,w <br /> OWNER PHONE: 1 OWNER EMAIL: <br /> CONTRACTOR NAME: M' j f,c)/ AL <br /> CONTRACTOR ADDRESS: STREET ?I'D% NiQ /f aq S. �y <br /> CITY ✓�O tM- i�A(\W� STATE VI pc zip <br /> CONTRACTOR PHONE: 2)(10 -L 2. t-13 25 CONTRACTOR EMAIL: St-e—f-A&I /!J <br /> CONTRACTOR LIC.#(REQUIRED): REy�i�SL�-5 Z L$ CITY OF EVERETT BUSINESS�` LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER IONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ?LW-Lj ZK 13 a <br /> J ! kar\ CAN J� CONTACT EMAIL: Stet"��1ef " (0),(1AGREEMENT:I hereby certify that/hqtA:t <br /> e 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 /> /I 44, <br /> (-71111 is E Ita0(1 0625 <br /> Owner •u onzed A.-nt Signature Date (Revised 9/23/2016) <br />