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4:77 ECTRICAL PERMIT AP (CATION <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 /> / PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: co-Do k"11cj I)Y- <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: Hilts ;{/'7OO/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ l U/ UL(J <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / <br /> DESCRIPTION OF WORK: /f 1 V- (/(a&I/2 0-r vfrl?0 .SGC KV ///a fl L.e .Sj fJ/Cf7'7. <br /> nn CONTACT INFORMATION <br /> /1 <br /> OWNER NAME: 7761kit kQci/(7v/ S 7cJ TENANT NAME(If Commercial): /(5 r/CG/i JL/7()/ <br /> OWNER MAILING ADDRESS: STREET 6-'7 <br /> JMU 1-7.2/7a-7'.�� <br /> CITY STATE /..,e.,/ifZIP Ig?/e./ <br /> OWNER PHONE: t-O--S ??S) <br /> /2 7 t( OWNER EMAIL: <br /> CONTRACTOR NAME: ?`-[D Ilia f- J �/ <br /> CONTRACTOR ADDRESS: STREET /670/ 3 ICh7 /NC? LA) £ Fr <br /> CITY L�j'nnu>C 0 49( STATE ZIP `q00-31 <br /> CONTRACTOR PHONE: `- �S �/ /C.pCP CONTRACTOR EMAIL: uli e : QfrJ/�Il'iJ 6,)a ,�r�D 5v/.€/ic- J. CC/19 <br /> CONTRACTOR LIC.#(REQUIRED): ScDf/!22 L ) CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 1c. �-- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �Q-� CONTACT PHONE: Lg2S7 1 1/60 L, , <br /> / 4'/2i7)J CONTACT EMAIL: Jjl/ie-ajci/'(� (��CG' ICO �LC &,r�r- (092 <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 /> E E \ look - 0\ Lk <br /> Owner/A tt 'zed Agent Signature Date (Revised 10/12/2015) <br />