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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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ,v' / e.e eye cer2aer <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: f,re.'� <br /> ELECT CAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: /'Lev,J <br /> NUMBER OF DEVICES (if low volt ge : <br /> FIRE ALARM? 0 YES -0-NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 441i e//7-17 &,xi,C'' <br /> CONTACT FORMATIO <br /> OWNER NAME:-j6--i/ ,3yj;g/{ ZA,j d 1�YI 5NANT NAME(If Commeraa : <br /> OWNER MAILING ADDRESS: STREET /f 2fV5= (CJ/h e xiE <br /> CIN /Jkt-/ lfedgN STATE /,'24//,'24/ ZIP f �,.J2 <br /> OWNER PHONE: ` z `f C� '�,�C�J / // OWNER EMAIL: <br /> CONTRACTOR NAME: L7//i//1/O,L 5-e.. ier.i)L/ ` ( //1i11ie,2/L&7rfJHS <br /> CONTRACTOR ADDRESS: / STREET/?..Q, a-2;4 3_1-6 f C y <br /> CITY All/19:72174 STATE / ) 1 ZIP <br /> CONTRACTOR PHONE:- [pQ '.;5' —/12 d6" CONTRACTOR EMAIL:/1c,.✓ iZ , z _,�_ <br /> CONTRACTOR LIC.#(REQUIRED):6.2L yfit, L-.7/z CITY OF EVERETT BUSINESS LIC.#(REQUIREI : 0310L <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTy� NAME: Y1 CONTACT PHONE:A(,a-(�j5 /v <br /> Mi /zit-et liIn/l r'`?...,(� CONTACT EMAIL:Nit_.), er.4 '5 LiGJC2°X�/'t'5 C E2r21 <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 lam 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 SlLy c 0 — 021 <br /> O er i uthorized Age S gnature Date (Revised 10/12/2015) <br />