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Cit4.77. ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwagov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: AZ,j C. (0(\Q <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: k.5(-0.:„....0— <br /> ELECTRICAL <br /> „,,;r.,, ,, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ (;,j iAf` \ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: x,,44 ”" u 4 I`t :•-UJ '- VtiLt-i-i—kk. <br /> .ter <br /> CONTACT INFORMATION <br /> OWNER NAME: 111-\ )( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 47I V t l�"". (asst <br /> CITY (p..° ,L WiNSTATE 14,011c- ZIP q- `S) t. <br /> OWNER PHONE:A7Gj•Cct)jj • ( ,(1 OWNER EMAIL: <br /> CONTRACTOR NAME: U,,,),,,,,4 ,{,,?\f ,t <br /> CONTRACTOR ADDRESS: STREET 11. �, • <br /> y CIT •M '�✓1..�"'�.L..p,..3 . STATE ZIP <br /> CONTRACTOR PHONE:L) (- CONTRACTOR EMAIL: x- CI Ii 't(,1 ' COM <br /> CONTRACTOR LIC.#(REQUIRED):(.i�.t1� .4'\ `?'SIL t! t-1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ` LAX l <br /> PRIMARY CONTACT: 0 OWNER itt CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Atz,G_--t.--k7 . <br /> CONTACT EMAIL: Qsz,4A. Ctilj rtA,t„i",(01.-- <br /> AGREEMENT <br /> C i .-AGREEMENT:T hereby certify that 1 have read and examined tins application and know the same to a 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 /> 43 Ln. 5--' <br /> PERMIT# <br /> i <br /> Owner uthorized Agent Signature, Date (Revised 10112'2015) <br />