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sOLTI CTRICAkL PERMIT AF _ICATION <br /> CITY 01: EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) weretteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT :i1TE INFORMATION <br /> PROJECT ADDRESS: B <br /> BUILDING AREA(if residential, new construction, remodel, or additic n) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS:_ C COMMERCIAL <br /> USE OF BUILDING: ac \N,>\VNNf <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): t C �I i c \ l C-C .VVA- ..31, Mcg <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): E u • Cj � <br /> DESCRIPTION OF WORK: ,1(l -�3�\ v -mac C -C..1, \Ap <br /> cGCc -, <br /> CONTACT INFORMATION <br /> OWNER NAME �j�' � \v\l\c J -' p\ 'Jj TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET (\`lames=t-•�-�•1�,-.. \� i( <br /> CITY LY-, \ -�\./._�Y���j STATE 12N- ZIPR CAS <br /> OW ER PHONE:he kC y t� p OWNE 2 EMAIL: <br /> CONTRACTOR NAME:6___.)L - • ` <br /> CONTRACTOR ADDRESS: STREET <br /> 'Q e".3C3 <br /> CITY Yui ( lid STATE <br /> ``�-� S : _J <br /> CONTRACTOR PHONE: Cc' • it:)" CONTF!ACTOR EMAIL:\jry <br /> CONTRACTOR LIC.#(REQUIRED):EA.ii- � �;� i D ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 01 HER(Please Specify) <br /> CONTACT NAME: CONTI.CT PHONE r, . LDS l(7-) ) <br /> ice\ COW/GT EMAIL:v <br /> AGREEMENT:T hereby certify that I have read and examined this application an( know the same to be true and correct. All provisions of laws and ordinances goverhing this <br /> type of work will be completed whether specified herein or not. The granting of a i ermit 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 au horized 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 WA C. <br /> City of Everett Official Use Only <br /> FEE <br /> - PERMIT# <br /> � � - ) lZ, E <br /> Owner/Authoriz-d Agent ignature ate (Revised 10/12/2015) <br />