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477 ESFCTRICAL PERMIT AP•ICATION <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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATIyON <br /> PROJECT ADDRESS: I (-) <br /> IV Y Nr':�1,� LJc <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: IR/COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ , , `t� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: - .�i A(! . _.,�v Wiz• (.+n�. ✓�i 1 CQ (2-ze <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 6'ecc) ACS <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i'/ rr ( <br /> CONTRACTOR ADDRESS: STREET J ( f) (j -- L.,-4-('1 O Lv , ) v v, 4 . a-- <br /> MY L 1/to/V L, 0 o�) STATE LL j A. ZIP /RC)( <br /> CONTRACTOR PHONE: _ / 7j tC CONTRACTOR EMAIL: J ceL I`k Coil) ryl Y�,leC <br /> Y ;C..�5c'C, C o I'-r-1 <br /> CONTRACTOR LIC.#(REQUIRED): J`11(„L[-L G (-10 C CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Cj!=�I <br /> PRIMARY CONTACT: 0 OWNER 0°CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> L✓C� <br /> (Lt. CONTACT EMAIL: ` CsE_L Coo YY�rC� L �r t c_c a <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 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 /> FEE <br /> / <br /> 1-[ <br /> PERMIT(: <br /> PERM T <br /> � I # <br /> E <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />