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• <br /> "'ELECCTRIICAL PERMIT IT APPLICATION <br /> ATIION <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 INFO I• MATRON <br /> . .. .. ... . . <br /> 1 PROJECT ADDRESS: /c Vci W r 7' ve- <br /> I BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ■ • ACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRIIC L ;,PPLLICAT9IN INFORMATION <br /> CONTRACT PRICE OF WOR JO a'), O <br /> NUMBER OF DEVICES(if low voltage):, <br /> FIRE ALARM? ❑YES )(NO <br /> ASSOCIATED BUILDING PERMIT#(i -•e 01e): / )) <br /> DESCRIPTION OF WORK: ans. ll ( (�.) I,.)0)A.�/) Y \ reeyhd/ i>o -,7 // <br /> -- <br /> C•N`I1°AC T I➢NFORM .TI ill <br /> l� ham St.) VD? ( )OWNER NAME: l C �� TENANT NAME If Commercial <br /> OWNER MAILING ADDRESS: STREET Mil Xp ,wl' ,4Y� <br /> CrfY Evr-P — STATE " // 2 ZIP >d-Ze/ <br /> OWNER PHONE: KC // OWNER EMAIL: <br /> CONTRACTOR NAME: VGJ/ht, nee,15,2 c.� <br /> CONTRACTOR ADDRESS: '` STReer /JUU 1//QY,-,YY cr A 12=-/ %'1 <br /> CITY Cfc I't• - STATE �� ZIP 9' ei <br /> CONTRACTOR PHONE: VZS- y0 2_ig 8 J7 CONTRACTOR EMAIL: ccay (ye rec/r/c- 4 ' <br /> CONTRACTOR LIC.#(REQUIRED): V4LLccCI&///V/ -wy+„„ -:yV36„CITY OF EVERETT BUSINESS LIC #(REQUI-.D): 0LZA�-j <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) ((,� <br /> CONTA AME: CONTACT PHONE: `�6(/.-S�Z— )I�'C/ <br /> G►vJ`Ci_ 1 <br /> ����� CONTACT EMAIL: 5c.� 1L �ri )�P/-Pf�Yic , Cr.�h-, <br /> AGREEMENT T here y certify tha I have read and examined this application and know the same to be true and correct All provisions of laws and ordin ces governin s <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 er state or <br /> local law regulating construction or the performance of construction. That!am authorized by the owner of this properly 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 FEE =1 <br /> 12 . 50 <br /> cyv.,. I <br /> PERMIT# <br /> /f /J7 E 12 - 090 <br /> • tfiorized Agent Signature Date (Revised 10/12/2015) <br /> 0 <br /> /2) <br />