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4677 ECTRICAL PERMIT API CATION <br /> 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: 9 09 S L even-c+1- <br /> BUILDING AREA(if residential, new construction, remodel, or addition) JJ SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: A COMMERCIAL <br /> USE OF BUILDING: { <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 0 0 <br /> NUMBER OF DEVICES (if low voltage): 7- <br /> FIRE ALARM? 0 YES th NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): NJ Pr <br /> n <br /> DESCRIPTION OF WORK: 42,p 1 cot_ Cx,b- � &' Pwre L c.$— I ?ad. <br /> CONTACT INFORMATION <br /> OWNER NAME: 0 cO b TENANT NAME(If Commercial): CM()6411 <br /> OWNER MAILING ADDRESS: STREET 9 n 5 j (.Q,1.4....4-4- 441.E 11 k../64..A3 <br /> /��^y /�] <br /> CITY rj Y1Cu�"'p{��' STATE ✓�JY ZIP _/Y <br /> OWNER PHONE: 9ZS-- 513- g^J 1 Q OWNER EMAIL: tU <br /> CONTRACTOR NAME: Pro 1<(.....9\i-al' r �` C,� <br /> CONTRACTOR ADDRESS: STREET .1,2A)2...(0 co �}.�Q, S <br /> CITYG1S -M lc...CAA— STATE�,"Gl}V�/I 3 ZIP Ci 32- <br /> ZS3-3 ` <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: CV AI`Q 71' W�Q,1�Q '!DfaGX CCM <br /> s� <br /> CONTRACTOR LIC.#(REQUIRED): pito-mot-0 333f CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 3 r-7 1441,3 <br /> PRIMARY CONTACT: ❑ OWNER AGONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> NAME: <br /> : f��, CONTACT PHONE: 2-53 ^Ect 5' iO3-0``►€4,Ael:4 -tAr 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 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 /> PERMIT# <br /> • <br /> EIA0OU <br /> O,ner7Aut • ized Agent Signature sate (Revised 10/12/2015) <br />