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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 )(E) everetteps©everettwa.gov I www.everettwa.gov/perm€ts <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: S3 Z l Co (b'{ 4v.E. ve-r -F- [AJ oq loco <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: 1405(,t it <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ S 000.o0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 1260 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: C-rt'a(— a Lab 51)a_ce_ 50 O (d <br /> Ccs b I-°AA&lei Cil • 3-W i 1C , S-F 1'toot- 1400(e_ c-cp he) Co <br /> A-&&tczyzex5 0914 re_-Cir& i e) C_ oma--/ (-3 <br /> CONTACT INFORMATION <br /> OWNER NAME: 7t"z► r On t t cENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET IeC)( L vtC( Ato t: CP') - :,0/(p <br /> CRY f eyt f ek stirs 6‘14- 1;2165— <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Vt.—C-4 E (e1...-tr,L <br /> CONTRACTOR ADDRESS: STREET 5(0 I � <br /> CSIr, 4 <br /> Ca? SSTATE 4-r4- <br /> ZIP /91O6 <br /> CONTRACTOR PHONE: 24,4)-L134•-5-20 f1; CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): V Ec 4E G1 2 M U CITY OF EVERETT BUSINESS LIC.#(REQUIRED): co Lei Sic <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR irOTHER(Please Specify) [s.L-lc1 r.,-e, ( �oPe ii 4 <br /> CONTACT NAME: CONTACT PHONE: 2.0 .950 -Q-623e <br /> 6-rt G tt CONTACTA <br /> EM tL5tsvL. Sc_40 C.wr <br /> AGREEMENT:!hereby certify that i have read and examined this application and know the same to be true and correct. All provisiors 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! <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAC. <br /> City of Everett Circle!Use Only <br /> PERMIT# <br /> E \e -3 <br /> er/Autho ed Agent Signature Date <br /> (Revised 9123!2076) <br />