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L LECTRICAL 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (, f PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: $h / �l,Ste Ave <br /> // q ) 5 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 41-`7s0SF 0 `00 <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑C MMERCIAL <br /> USE OF BUILDING: gc 5;A e•--iCe <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ] / <br /> DESCRIPTION OF WORK: //tp,r�l � ,v1 S �LICd1O 1 )- S 9 , (,ll 3 <br /> j t-ri)i C- <br /> CONTACT INFORMATION <br /> OWNER NAME: 00 6\_ edkK TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY <br /> STATE ZIP <br /> OWNER PHONE: .26 7 3 '7 OZ�O OWNER EMAIL: <br /> CONTRACTOR NAME: L—D f . E1 e(C (5.1 f/ 7�— <br /> CONTRACTOR ADDRESS: STREET�/� L 7 J 5 (J ( f (_ /, / <br /> CITY `1 " JL/J1'/1(1-2 STATE(�/ CI ) ZIP Q(�� )7 1 <br /> CONTRACTOR PHONE: �`tj- 6 5) -r615 Z— CONTRACTOR EMAIL: ,�, i J`S Efej- 'sc ic\C t// (y/?'1.4( f,C-Z�1�`l <br /> CONTRACTOR LIC.#(REQUIRED): t M .L9 2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 9)7494 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4-f-) -5 et-it 7 7 1 e <br /> )._,>(-6)6 CONTACT EMAIL: k,pdlS E �G ` (�1 G. F (r.'i'!^�+ f. c_D <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 /> L 16' 327 6$ <br /> City of Everett Official Use Only <br /> PERMIT# ^ <br /> Owner%Authorized Agent Signature Date (Revised 9/23/2016) <br />