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A0111Py "-- ELECTRICAL PERMIT PLICATION <br /> 4 <br /> WCITY®F EVERETT PERMIT SERVICES <br /> wit4 <br /> _ 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everefteps@evereftwa.gov I www.everettwa.gov/permits <br /> -maaMserSaMir <br /> PROJECT SITE INFORMATION <br /> i <br /> PROJECT ADDRESS: 1 it sr (0 eK)fril re2jk bk/al 6 yett. , /1 .„ ., , <br /> BUILDING AREA(if residential,new constructioii,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: I-10 fig I lip fig <br /> ,................... <br /> -___ ELECTRICAL APPLICATION INFORMATION <br /> Cs)NTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): U <br /> FIRE ALARM? DYES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,..._____, <br /> 4 I P <br /> IP ESCR1P l'eN OF WORK: COMM Nat,- -0 all 1 111)illel War. • S. : <br /> ,.. <br /> CONTACT INFORMATION • <br /> OWNER NA " teaverk my, pvj ,f2„/AR/TENANT NAME(If Commercial):;114,, MSIPAri (SA-MO <br /> OWNER MAILING ADDRESS: STREET „..„4 , <br /> mrs- s,f-si„ w /424 <br /> CITY Ade CI STATEAPO A <br /> ZIP Apr <br /> ... <br /> OWNER PHONE:125-:2A'7-ol .6-- OWNEREMAIL: <br /> CONTRACT,R NAME: <br /> 44- .-..,„,,• <br /> CONTRACTOR ADDRESS: STREET • 1- <br /> ; 5ntitk br ......0, <br /> cm( • i - 9 <br /> 4" STATE /7414 ZIP dr i <br /> CONTRACTOR PHONE: (j7 (s073 900 CONTRACT•R EMAIL: , • Ce/404.4cm <br /> LeINTRACTOR LIC.CREQUIRED):14-Eilinikiicie).1 L CITY OF VERETT BUSINESS LIC.#(REQUIRED): ; <br /> PRHYr hol—+------irrAcT: 0-0-1/ITN-EFT-71---0NT CRA TOR 0 OTHER(Please Specify) <br /> CONTAC3,NAME: ,N /) C.NTACT PHONE: KX) <br /> CR SW. (PfuOic.-- alp. . ...„ <br /> CONTACT EMAILCY ( 1 Ca lir AM:VA Niof IAAS\ t COM <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 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 /> I PERMIT# <br /> ........_ <br /> .01111111M ...iiiiL--- ___ 5-12 14:1 E 1 ci0 - 7--6_ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />