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flee t=IWA 4.a • <br /> Cell t c1 <br /> (477- <br /> ELECTRICAL PERMIT APPLICATIL.B <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 /> :� • � P.RQdEPT:WEINFORMNT1CiJlt•.:' <br /> PROJECT ADDRESS: .2..500 (-gw I N vE! 1 i` t 2O0 <br /> • <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> _ ELECTRICAL ANkiii T1OH INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2`d %? <br /> NUMBER OF DEVICES(if low voltage): <br /> -FIRE ALARM? ❑YES la NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1.)i5-r4i_c- v L-rp-G SEC R(7-7( 5.f 57-air - SEA - I St-1$$ <br /> CONT.ACt ILFORMATION <br /> OWNER NAME: r .b TENANT NAME(If Commercial): S SAO 4. F 0 D <br /> OWNER MAILING ADDRESS: STREET 23'25 7 q 14 A tI>r .E <br /> CITY LJ4liLEt; 571E\h it)S STATE LA..)g ZIP Q32� <br /> OWNER PHONE: 25-- 50(- O Jco OWNER EMAIL: <br /> CONTRACTOR NAME: A20)03(31.-2 3EC .) T'' j-?.Out <br /> CONTRACTOR ADDRESS: STREET (p00 OA. E5iALE f' <br /> cri R ION STATE WI) ZIP SGS 7 <br /> CONTRACTOR PHONE: 2o,- `, `! - 355 3 CONTRACTOR EMAIL:PA/L..;A O JSC1. e AP.tPvxfi,)St-i 2 iTY-C:ofr'l <br /> CONTRACTOR LIC-#(REQUIRED): ARAlOSS&C)E 3( (s CITY OF EVERETT BUSINESS LIC-#(REQUIRED):OS I SS-7 <br /> PRIMARY CONTACT: ❑OWNER 1:X CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 20c,- 4-4 f <br /> t aE 75ot.J CONTACT EMAIL: (?AWL.tkk;_v�sc::3 ARK)i�SO!'$ C& l T 1=. e (Vi <br /> AGREEMENT:T hereby certify that have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> tvoe 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!am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Oficial Use Only <br /> 1 FEEz, <br /> 5 .00 <br /> -- PER O it <br /> 3,2 <br /> OwnerlAuthorized Agent Signature Date (Revised 10112/20151 <br />