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l � �G ►� 576 Zod/oii'C 47-7- S <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3LOl Sri, 4L( <br /> BUILDING AREA(if residential, new construction, remodel,or addition) a ,41'01/\ SF 2-5-00 <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: b(,4i.lot C/�e114/1-‘-e--t CA-e•-• <br /> (� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z1 g:y, 7Z, <br /> NUMBER OF DEVICES (if low voltage): <br /> "FIRE ALARM? 0 YES tBCNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): JJf <br /> DESCRIPTION OF WORK: ON'ti1 C.K.�.GZ ‘OYI 00-C• a <br /> I V (*J✓VICI J2 ' <br /> tor pit42v5 <br /> CONTACT INFORMATION <br /> OWNER NAME: 'O -E € -i' 20z)to j��.3 , ,1J NANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3�Q{f SJYt '4 et/ <br /> CITY v`�'` -I I STATE ZIP / y.20 <br /> OWNER PHONE: y 25.--7?3 - 672'4 ��--- OWNER EMAIL: . d x UQ fl y\)2 �� <br /> 0 Q, Oyy- <br /> CONTRACTOR NAME: /1\i14-r7yvlc -,i l'.�j YYlf V\ fCCo <br /> CONTRACTOR ADDRESS: STREET I QJ ) may-3 1,exp �o(,(.l �- , <br /> CITY -, il'`)--f'-{Q/ STATE (AI ZIP - L8 <br /> CONTRACTOR PHONE:20(0231.12-7 — // 87) CONTRACTOR EMAIL: t'Y►t'ko_Q .C. OILS . C / <br /> CONTRACTOR LIC.#(REQUIRED): Auto rip-G 33 �j) CITY OF EVERETT BUSINI SS LIC.#(REQUIRED): (J i1ry 7 <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify),e X (J rI eat/15 <br /> CONTACT NAME: CONTACT PHONE: j-�) 3.072`'1 <br /> I'eyC G ir��Cti,�l'LS CONTACT EMAIL: )S In v)L,00 . Law' <br /> AGREEMENT:T hereby certify that 1 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 t 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 /> krPERMIT# <br /> 7. <br /> Ower/Authorized Agent Signatur,, Date (Revised 10/12/2015) <br />