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• <br /> ELECTRICAL PERMIT APPLICATION <br /> /111P•41 ----A_ 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 /> • <br /> PROJECT ADDRESS: 300—. 1,3 U,S"NM gcX. �")J,I 0El .rl LID 5g C k c,-1/1 c- 3 <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: COMMERCIAL <br /> USE OF BUILDING: 0 J ( 1(A <br /> ELECTRICAL APPLICATION INFORMATION • <br /> CONTRACT PRICE OF WORK: $ / OD 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES t4 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): m �� <br /> DESCRIPTION OF WORK: �!'15-�c,(\ 1i LL) t„'L-4-( j�-I- Mc, 1.);,(11._ vor 1'IrAncAGr U: <br /> _ 2 CONTACT INFORMATION <br /> OWNER NAME: -1`r1A. VOA,('c) Corn kny TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> • <br /> CITY STATE ZIP <br /> OWNER PHONE: 1 OWNER EMAIL: <br /> CONTRACTOR NAME: (,.Or'\-�-co i £ " nr�M Lc;M � 1 C..• <br /> CONTRACTOR ADDRESS: STREET 2i E I' IrnC; J2 l <br /> CITY -' C_, 'I I' STATE \jU"\ ZIP 9 i2u <br /> CONTRACTOR PHONE: 42.S-Si 3-Cf Ol W CONTRACTOR EMAIL: C.01+CAL-t (A i(1 t,.). C.0(v\ <br /> CONTRACTOR LIC.#(REQUIRED): Ci7V al Aell CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0�33�7 <br /> PRIMARY CONTACT: 0 OWNER 1(CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2_0(a '1 Lf5D� <br /> cot I ICDoL)e- CONTACT EMAIL: C1•tifC a'1in .'UA n <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 of 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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> • <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 9/ <br /> ) E 1-6, 1 <br /> Owner/Authorized Agent Signature Dat� <br /> 9 9 (Revised 923/2016) <br />