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. :;Sss f • <br /> CAl.� i; d C-6. <br /> 47r ELECTRICAL PERMIT APLICATIL.m <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 ) FAX 425-257-8857 I (E) everetteps@everettwagov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION. <br /> PROJECT ADDRESS: Clo0 PAC/FIC- A\JR. <br /> BUILDING AREA(if residential,new construction,remodel. or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS. 724 COMMERCIAL <br /> USE OF BUILDING: <br /> • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1$50 <br /> NUMBER OF DEVICES if low volta•e : I <br /> FIRE ALARM? 0 YES '$NO <br /> ASSOCIATED BUILDING PERMIT# if a••Iicable): <br /> DESCRIPTION OF WORK: jg ALS L.f,t uoE-r A6E TY ,4/5 a- SEA —iio000 <br /> TZ V/El cti ICA L Pam <br /> M CONTACT INFORMATION. <br /> OWNER NAME: PR a%)r'DE E. 1•! P iC:414i.CES t e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET LPo g01C 0107 1 o f� q Q 3p �y <br /> CITY E d EI l�Tr STATE l.l.�/ r ZIP 'J�l:' "" <br /> OWNER PHONE: 4 i5-"2(t--39 13 OWNER EMAIL: <br /> CONTRACTOR NAME: AR0/0501-) SEC V€ I Ty c iok_3f' <br /> CONTRACTOR ADDRESS: STREET (OO to k,E$.��1C. A V E- 9 G�^ <br /> CITY p.IL�J T Of'- STATE L�i r4 ZIP J O5 ! <br /> CONTRACTOR PHONE: 20(c, .2A `I - 355 3 CONTRACTOR EMAIL:PAih-;ACOk.ISC4je Ae N tvSECu D iYY Cori) <br /> CONTRACTOR LIC.#(REQUIRED): AR.O .JSS&01 .5 C ice, CITY OF EVERETT BUSINESS L1C.#(REQUIRED):O31 C(F5 7 • <br /> PRIMARY CONTACT: 0 OWNER ii1 CONTRACTOR 0 OTHER(Please Specify) <br /> ()CONTACT NAME: TCONTACT PHONE: 2��i1 .. z tl 5- ( �-j <br /> I <br /> F A w .r i (....�. 1 <br /> CF '.7t ��ttiSOkj [CONTACT EMAIL: PAUL..Aci..CIVSCJ.:( { ^�.:`7SCt'— 4vs t"r r e eefi <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be 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 /> 4k' <br /> ! r <br /> I PERMIT# <br /> / i <br /> t,t <br /> �� (_-' _. 12.12 ico I . &, 01 <br /> .0 <br /> Owner/Authorized Agent:5ignature - Date {Revised 10/12/2015) <br />