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477- 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: 1 _1 I -t t�-u j -� �J �i�-� �V �-� N/-r� <br /> 9 2o 4- <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: <br /> ELECTRICAL <br /> y�APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ lil�CJ� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: I (v I L!_ w I` Cki A Ni L L 17 St el <br /> `\J <br /> OCU l_l . A HzoN-T LL <br /> CONTACT INFORMATION <br /> OWNER NAME: ['f ( TENANT NAME(If Commercial): Ro P[ Z?CJ` <br /> OWNER MAILING ADDRESS: STREET li ! �Z ,Z - y�,! WIAL( )X-127-11-, Lk) –)a 4- <br /> CITY �' i) �- �'1 i�, STATE w A ZIP � I <br /> OWNER PHONE: 4-�Lj �� 9 OWNER EMAIL: Ci C V l o G', M C—01\r/Ai i\ o]1Alli\v. I,CC C 1) <br /> CONTRACTOR NAME: NO k,t 5 N Lon) S I -Et-K) C7 <br /> CONTRACTOR ADDRESS: STREET `2 � b (00'j- 3 VJ <br /> CITY UVK� - STATE . 1 ZIP CIN <br /> 1 7 U� <br /> CONTRACTOR PHONE: it --0 .134._ CONTRACTOR EMAIL:-els C Q 0`-0 . <br /> CONTRACTOR LIC.#(REQUIRED): IUB I K-T-5)J 4, 0 ?i3 Gig CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: \\ CONTACT PHONE: .— 2-50 )j0�6 f <br /> c E.V t CONTACT EMAIL: 1-"y/N.,...4--(7.Q_(.7.;21--i- J2 �l 0 C4- .Co <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to bee 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 /> ql) 1°V- <br /> PERMIT# <br /> (f/-/? . �� ��E I '7j Owner/AuthorizeSignature Date (Revised 10/12/2015) <br />