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ECTRICAL PERMIT APFCATION <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 www.everettwa.gov/permits <br /> �,„�a�' ,.� :"�'a� :: `3' ,� `�` x t� �'�' '�` .�+.roe ^,�.a e t� .�z* sarss- n .: a.. ,tl�� %'3 ,e:� '�� �'" '�'a,� ., % �, '`_',c '�'' $" <br /> fr PROJECT SITE INFORMATION 4 E P„r , ,7 ' °x <br /> PROJECT ADDRESS: i L.1 Oa_ 12 sArkL1 A <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED- 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> .. .. „v. a *., d� .,. ... _, et.,... ..n ai(c., ..,.e..{.,r. _ L_. ... .A ..aF.'r:. ,., w. ..r� ta... ..0.. v.fi,.4.x,. r. ., n. .r. ✓gym ..0 rM ;-.�'i,.. .tidsr YV.a.., <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES jNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Q.80\QQ_ y ` Q\ (i\SVSQ'' 5 - \ \N s <br /> CONTACT INFORMATION <br /> OWNER NAME: C \ \Ac C\QA..)cOtA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET MVV\Q <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'S_v\AA,vQ q\due �_`.QCAWZ.. �V�C <br /> CONTRACTOR ADDRESS: STREET %O\\'1 V•ov Ntwk R rJ� <br /> CITY . `>Pive'- STATE W' ZIP C\ <br /> CONTRACTOR PHONE:-2S kSSO "1%Q3 CONTRACTOR EMAIL: J\ys \N ou AN\vQ`-L.`Qd11',C ,Co 1M <br /> CONTRACTOR LIC.#(REQUIREDFX.NWeNQX0S.S Y CITY OF EVERETT BUSINESS LIC.#(REQUIRED):US562.g, <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �C.To 1 ,�p,4 <br /> \V‘/' Qj U\ t`\ 1Q'I\ CONTACT EMAIL: <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 lam 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 /> FEE <br /> \59', D <br /> PERMIT# <br /> Ow er Uthorized A!- Si'nature Date (Revised 10/92/2015) <br />