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I t. 1.40 <br /> OLT ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettvva.gov I www,everettwa.govipermits <br /> PROJECT SITE INFORMATION <br /> PRo.. 2(2..q2_ <br /> 3L/ILDiNG ARZA c. -i J31.'1' PaVi Z%-ani'''JV a, ri ... x 3 WOO) SP <br /> USE OF 3U:LD:N3. <br /> ELECTRICAL APPLICATION,INFORM4TION <br /> CONTRACT PRICE OF WORK: S-7----77:77.- ----""--.."---**---- —"'"---""--"*--------- <br /> --- <br /> NUMBER OF DEVICES (ir low vofta e): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(V applk;able) <br /> ........ <br /> _DESCRIPTION_OF_WORK: <br /> f - . <br /> likAh..115, O. ° Mt, I 411k "et& ..1,... .1-1102111111111 <br /> ' - is • i ' 0 ' <br /> ill ..... ..... ii... - ...,s di. .,.. 'do t ' 4-.. <br /> , . <br /> _ . <br /> iroNtAdtiNFORNAtioN <br /> OWNER NAME 4. li a V. la -Akt - TENANT NAME(If Co.rnmaroial <br /> OWNER MAILINC4 ADDRESS: - ..- ,• <br /> Ir <br /> ti i <br /> i le iip7.'11FIWII <br /> -.; ow - ' ...: <br /> 3TATE ' LIP & <br /> OWNER PHONE: ... 40• 4-k E0 OWNER EMAIL: <br /> ::,"DNTRAOTOR NAME: I), AA tkiall P D <br /> k,-- <br /> ^ <br /> STATE A 4\-- ZIP CI* 20 <br /> -r, ii, <br /> OONTRACTOR PHONE: 6,j,.7If,"I w 41... CONTRACTOR EMAIL: • ",,, ' MI 40 I , 4 rIll <br /> — C:ONTRACTOR CTC:--#1q—Ei5D-ikED):110 ' I Wt.' —17(171— <br /> dIT(OF-EVE'RETT BUSINESS LIC.#(REOUIRED): i a 0 <br /> PRIMARY CONTACT: 0 OWNER ti CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 5 35C1 OLT-"" t <br /> I 'elk ie CONTACT EMAIL: deb 0/ . 0 vit.ctri .cern <br /> AGREEMENT-I hereby cerri61 that I have read and examined This application and know the same to be true and correct. All provisions of la;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 at this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 16.27 ROW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> €j3/2tet_L..,S0-11-03 ' ica). b E l$L0 - l s 5 <br /> Cvyner/Aetticrizeti Agent sIgnature <br /> Cate <br /> (Revised 9/23/2Cr 6) <br />