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ELECTRICAL PERMIT A LIGATION <br /> #111111P/4.4....27-0—.4 <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: �I is 1'I i G s4. <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 100 0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 21'COMMERCIAL <br /> USE OF BUILDING: 11.0fe <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /?0-0. <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): LEO DESCRIPTION OF WORK: aP( ,ncp D(d iYfv(Q 5 4-o L/. O } u4'a cr+ <br /> 11 t[nr r e Geta a.CleS. <br /> CONTACT INFORMATION <br /> OWNER NAME: Hol[Cblld ld -ph VQy-n afl 4 , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (f 19 /V• Co M Qr G r o( S'( (4264. .S u t-1-Qe, 16C► <br /> /� crry IJek1%l�0 STATE W`J ZIP 61pq <br /> 1-i14-1:1434CIFT <br /> 22S <br /> OWNER PHONE: 30° 9401 1'" OWNER EMAIL: Se-1 rr0 Kno((ooJ C <br /> CONTRACTOR NAME: Fto1100d4.r J yt Vas}n,0 ,4S.. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> .w.w....�..,�.m.... ...,.,..,, ..�s x.,..�:.�....,.-..M, ... .........»,....,W.._....,....,... ._ .w......«_..,.. ,.w....u.,.�,....k-........:........ ..,., ._��.....� .�,..w,....r_.,....... <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Q-r ^�Q � CONTACT PHONE: '360 ?.do2 I rj S <br /> `�`�e9 �/� <br /> °I r` - 14 CONTACT EMAIL: SG(Y / kol ie vietav 1(tV.gs-yrYtevn4s•coo,• <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 /> 6147 PERMIT# <br /> 1 - 16, E (C00 - 0(3 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />