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OLT ILECTRICAL PERMIT API CATION <br /> CITY 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: t,SQLI vieminc, <br /> BUILDING AREA(if residential, new construction, emode or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-*OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 4-4cm / - �.. e <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z5o0 co <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YESO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: W j2C- f 1oo1 <br /> CONTACT INFORMATION <br /> OWNER NAME: t(Y1GUi ('C- -t & e W(w r'T TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 0304 'I'te.w.i A5ST <br /> Cr!'! t ' 64,e/^r- STATE IA/1°y- ZIP -/g2 d <br /> OWNER PHONE: 42-5- -'SAOO OWNER EMAIL: <br /> CONTRACTOR NAME: 'Don elms., k C C. <br /> CONTRACTOR ADDRESS: STREET I"1 1 ftJoriy,, bty im,p)(� g p <br /> CITY / „�"` ZIP {, <br /> CONTRACTOR PHONE: (-12.5--35 q- (0L(18 Ilk-CONTRACTOR EMAIL: ,(S(, e1PAJ-(�,`�„ .� tb 7Dy <br /> CONTRACTOR LIC.*(REQUIRED): OW\nee1.0�t�1 rte. CITY OF EVERETT BUSINESS LIC.*(REQUIRED. O3 t &37 <br /> PRIMARY CONTACT: 1]OWNER V1-CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L ZrJ_351._ <br /> ( //e <br /> fin ote, CONTACT EMAIL: wIllP,lso+.7 L1'�f'f1LiL e emccit.a.-•coin <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 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 /> FEE <br /> t.CC) <br /> PERMIT* <br /> /6z18 E 5 <br /> owner/A 1�•ge t Signature Date (Revised 10/12/2015) <br />