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4-17 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@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5Q I q E erq r-.e.,.ert. W O / <br /> BUILDING AREA(if residential,new construction,remodel,or addition) j SF pod 409 <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: JrZiCOMMERCIAL <br /> USE OF BUILDING: (()h/1merci'al Re f-'ai <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ W 31000,00 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 8pp I e con Jc rs n 3 ( {ry"Q p;+ - LAX 'rlb bej <br /> /.4a 2- n>✓ i X�-t]Y,c c r�e n� �a�-c Lr Z ft x �rC s, A del <br /> 2. <br /> 4t'IA A xi-ores WI4i-c 1I'ng ex r'sri n9 4 rcp Iq C.A.- of7 -Pi Ki'- r" S <br /> CONTACT INFORMATION <br /> OWNER NAME: LgIJV •Petbr i Zi 0 TENANT NAME(If Commercial): y)4 c W)>2p-PC <br /> OWNER MAILING ADDRESS: STREET�y{266 60454. v cIc J p <br /> ✓ <br /> CITY { Yl: Cv 6 j STATE 1 L ZIP 6044 I <br /> OWNER PHONE: 6C19".. g 2Z. to/04 SOWNER EMAIL: IC Ora . FA,broi'2,63 AIli,jI1 •C.O&'Y! <br /> CONTRACTOR NAME: I.-1'N R QC/.ers & le c...ty Al CDIi+V'cic:A-c VS <br /> CONTRACTOR ADDRESS: STREET ()1r0O /V( yt py); P 1^ /y <br /> CITY A t p�,Av-e.11- /c4 STATE (,�ig ZIP 3�./�4„O5 <br /> CONTRACTOR PHONE:'1 76 772, L344 2, CONTRACTOR EMAIL: 1 r(rt y',Se(Q/VOle Qle+C, riC,. zoisi <br /> CONTRACTOR LIC.#(REQUIRED): &C. (L,Q 95681 CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 3l <br /> PRIMARY CONTACT: ❑OWNER A CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Ka 'ge r t l t CONTACT PHONE: 7 70 7 7 2 3 t t 2 <br /> t CONTACT EMAIL: ' CC-e 14 Se I rc c e r.se t tc'F1r,'c• <Jail <br /> AGREEMENT:I 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 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 lam 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 /> E ��J1 �lq <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />