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4ETT EC R1!CAL PES hfili , /f1V:_ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: / . / <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: /ik5/4f i iq�L <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 7 , �pv <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /2(e f� / ,,,,5 T,4-u Avbw PSC_ � •titErE.ef.._ ECUS <br /> CONTACT INFORMATION <br /> OWNER NAME: C`�el/,,77/74- Ca o+•/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /$2/ Vf q <br /> CnY �5/LEjlt' STATE CA.../9 ZIP rSZC)/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: c s A , c u_ - <br /> CONTRACTOR ADDRESS: STREET 2Z6, /3Cj b iv(e <br /> CITY e-4/L.c- �?j.�/E/✓ STATE U-• ZIP q o ZS-13 <br /> CONTRACTOR PHONE: L(Z c 2 yy 5-57/ CONTRACTOR EMAIL: 5ccicE fri .14YS�..r !s . i c . co.,,, <br /> CONTRACTOR LIC.#(REQUIRED): Sw, rcc /.1g. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OS25-S4 <br /> PRIMARY CONTACT: XOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 45— .764: , /-..4/4/ <br /> CONTACT EMAIL: (/ -r/ill.L/mar✓3Ss eC 4�c c�,•, <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 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 /> 1-EE <br /> 1 DD <br /> PERMIT# <br /> E ( (010, - ( 1+ <br /> Owner/Autho " e Agent Signat re ate (Revised 10/12/2015) <br />