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ELECTRICAL PERMIT APPLICATION <br /> •41 -.01‘,74 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION� <br /> PROJECT ADDRESS: 15/6 6 112,e,APO t )/�-Y 763/ <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: •E COMMERCIAL <br /> USE OF BUILDING: acr*IL. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ Z.(op 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES i2(NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: II' 8"tr rye/ALT!-fkte,"y' D/' tact,(/ <br /> Lr O , ( ..t.--y`c$/ <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 0 f/26.f/(Y ,4-c_f 404,-4-1 <br /> OWNER MAILING ADDRESS: STREET / <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ��b Qi fjy fry74-4/4--6- A,1t '7 1vG-- 4G <br /> CONTRACTOR ADDRESS: z.Terv' 630S_ • <br /> 6I <br /> /©d / y� / <br /> CITY <br /> P1 - it STATE M/1/ <'IP 7 /b <br /> CONTRACTOR PHONE: 6Ia-7,(47 s-/C, CONTRACTOR EMAIL: i 4 670.74-V C? E%/YtG GLC• ['d�✓+ <br /> CONTRACTOR LIC.#(REQUIRED): 6.4)672 Gs41 G 13:30 L-' CITY OF EVERETT BUSINESS LIC.#(REQUIRED):063377 <br /> PRIMARY CONTACT: 0 OWNER 1WCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 6/6k-7Y?—.,?,S-t/'/ <br /> /'►�Xt-ri/ I"(/ L&M14-% CONTACT EMAIL: M Le/vJi4-t' (iMG £Gt'i . COitof <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 1 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 /> /Mb - E \ Qo I - IOwner/Authorized Agent Signature Date (Revised 9/23/2016) <br />