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• 411/ <br /> 4677- ELECTRICAL 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 /> PROJECT`SITE INFORMATION <br /> PROJECT ADDRESS: 30O 5 W Ccj ry ila• 9SV;I(l 1,1 t ,c� <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: �� ' ( cn 1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Zy Ci L1(1 ( (] <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES X.NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: —LocriG LQC. JCt ivk,C ra,Q. <br /> CONTACT INFORMATION <br /> OWNER NAME: -MR. S��„(-c Cam Q(,\n�./ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET r <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 14-col IJY iii l L• <br /> CONTRACTOR ADDRESS: STREET 2.1 y no,,i�`' I �L, R. <br /> CITY •J(J' I STATE `i0A ZIP l 020 <br /> CONTRACTOR PHONE: 425`Si 3 c C>I CONTRACTOR EMAIL: Co Yfc�C.-�-( (J,()L ). (O''\ <br /> CONTRACTOR LIC.#(REQUIRED): (0 1K 1 otoi CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C)S - 1,7 <br /> PRIMARY CONTACT: 0 OWNER )(CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZOL:- I �- <br /> �I cAki MC.i)6Qc-I CONTACT EMAIL: o_c('L;4'it'V1 (?1_.). co <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 /> City of Everett Official Use Only <br /> PERMIT# <br /> i�i E i3O [ 0 2/.0(0 <br /> Owner/Authorized Agent Signature Date (Revised 923/2016) <br />