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ELECTRICAL PERMIT 1- PLICATION <br /> OrEn. 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 /> • PROJECTISITE INFORMATION <br /> PROJECT ADDRESS: —HO 19) 2z e-hIOLN (/t I' IP) n <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF ler�1 T'o''"y <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> � <br /> USE OF BUILDING: All", - S <br /> V ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ '2-a , <br /> ct <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES $.NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I v 0 <br /> DESCRIPTION OF WORK: C kfr- \'‘IX :-560 J,�-vim.'g k6 Iti1 <br /> C., 14-1'G J' '1 -�^qtr \1"l�t� <br /> 2 )(ine,I,s (ems u I L <br /> CONTACT INFORMATION • <br /> OWNER NAME: �i kc 1\ 1-1-zt): *t- TENANT NAME(If Commercial): r 7 <br /> OWNER ADDRESS: STREET l �'' 00 60 ` �tW�K 4 ) 5J-1- ;03 5 `1%1 <br /> V `41 3 C 3 <br /> Y . /i C I t gg`-t�E CITY `^—L- . STATE l ✓ I C ZIP <br /> OWNER PHONE: "i 2 S 2 3S 031 OWNER EMAIL: C 6-01 °*f'^"'GO"�" I(° (.6 <br /> CONTRACTOR NAME: C6 (MQ. ...G.'.1C- ... t-C LA_ C <br /> CONTRACTOI R ADDRESS: STREET .0. 3o x 4'Z '- -71 Or..) 7 eke <br /> S• E <br /> 1 . <br /> S✓w l� CITY ( - STATE "` 0 ZIP <br /> CONTRACTOR PHONE: `7o(, G(ZZ. (q 5'7 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CG W PL e S S S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OrjL 561 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 <br /> OTHER(Please Specify) _...•.....•.. �� ._ ,._,...._ _... _..w__....... .....:. <br /> CONTACT NAME: ��/� CONTACT PHONE: 1`Z oG L{2 Z (C,s'Z <br /> T j: 1 \ � " �p `/� CONTACT EMAIL: Tj GO .M r(v t-Q jr--) crLD6 . co•"N.. <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 Wnd 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 /> co <br /> t <br /> I <br /> PERMIT# <br /> a . �. E Haa_nsL <br /> Owner/Authorized Agent Signaturell a ate (Revised 10/12/2015) <br />