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Olerr° OPECTRICAL 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: J U67- --100 Av <br /> BUILDING AREA(if residential, new constrjctio , emode,, r addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED `,I SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: �3 — <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3-cO <br /> NUMBER OF DEVICES(if low voltage): 4-�� ) Met 09 C& � �'� ��( ;Ata <br /> FIRE ALARM? ❑YES ti(NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Int 62 ri —O 3 <br /> DESCRIPTION OF WORK: 1 iX ) vC 1 1J C'_0 r k l ( U { t Yl3 . cC. e'u P(U-eA.'T <br /> Mtl p l l-C 17 <br /> CONTACT INFORMATION <br /> OWNER NAME: -1-eofl G 5f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Ibtt ip— /�/y/�1, <br /> \ CITY � J STATE njA ZIP <Ua6 <br /> OWNER PHONE: (�a f LQ''j6 8(dp( OWNER EMAIL: y\�e M -62)� <br /> 1-e-bcfYlel <br /> 'J <br /> CONTRACTOR NAME: Inc\ rtecu ty , <br /> CONTRACTOR ADDRESS: j STREET (1 1 C, <br /> CITY �a�d (J STATE <br /> ��11 � ' II ZIP q�f`, <br /> CONTRACTOR PHONE: ��(J'j a-M S-3 CONTRACTOR EMAIL: i'Y1 i L�ifa Q�ll,L C 1(.4r� er _ WV\-- <br /> CONTRACTOR LIC.#(REQUIRED): ( S 411 S L LB CITY OF EVERETT BUSINESS LIC.#(REQUIRED):L5 ( /,U <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: {�� CONTACT PHONE: Cwl. l� 3 —L qq <br /> U\(-6 �'Il�, I� CONTACT EMAIL: ^ 5 --P...6419-(6,6\A„AGREEMENT:I hereby certify that I havd�road and examined this application and know the same to be true and correct. All provision f laws and ordrances governing this type <br /> 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 /> PERMIT# <br /> I /le file Eh!(.01(L40 ,19 <br /> Owner/Autho Ize. Agent Si..:ture Date (Revised 9/23/2016) <br />