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kECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> milay <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> - PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: L4P a G!z_e4-h®f=-e <br /> BUILDING AREA(if residential,new construction,remodel,or addition) QQW1OI Q. SF • <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: IAl COMMERCIAL <br /> USE OF BUILDING: R <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ` ) SVC) <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? 0 YES -LI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ,D_.11040C /4)11e <br /> ,( U 12 •� <br /> 7 // 2Q'o 9c1v.3 Amp 3 . -Q 5Qrhv -'Q . , <br /> CONTACT,INFORMATION. <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> cm( STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: / )42:5 i') glec-i-oe CO <br /> CONTRACTOR ADDRESS: STREET /716/ rntry a 1 K 7 <br /> ".n,7 D hr-s- -s-a 1- CITY STATE to 4' ZIP / Ci n <br /> 7 --.� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.NREQUIRED): QJg rUPy 4l, CITY OF EVERETT BUSINESS LIC.#(REQ -ED):2j7905- <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: [_ .s ? I Nr <br /> mte-Act4,1 tr i CONTACT EMAIL: Y'U16e5 n 16C.4eZ --eT ky- <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!am authorized by the owner of this property to perform the work for which application is made and! <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 /> a /7- 079 /7 E (I t( � <br /> �A� �� Rise <br /> Own !Authorized Agent gnature Date (Revised 10/12/2015) <br />