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• ELECT FLICAL 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 /> 1I PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3 013 LA1'4.14 54 <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: IJI yC4A- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ I U/ gt-( 7 <br /> NUMBER OF DEVICES(if low voltage): I 0 <br /> FIRE ALARM? 0 YES 41-NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): _ , n �� c <br /> DESCRIPTION OF WORK: , �-�t.o-�e�,1I `O CCA tr LQ C& , <br /> I <br /> CONTACT INFORMATION <br /> OWNER NAME: (51,ra i In I-e /� 1✓TENANT NAME(If C mmercial): <br /> OWNER MAILING ADDRESS: s EET 3 0)111, '• r I (.1-4- <br /> r+ S LAA- <br /> CITU Cv J`e A-C*4W V STATE L/- ' ZIP y 25-2 o 1 <br /> OWNER PHONE: l OWNER EMAIL: <br /> CONTRACTOR NAME: Pf V:WrAt CNN.7i Vt/V r c <br /> CONTRACTOR ADDRESS: STREET 1220 C c,-: `1 Ave v• �(n� 4 <br /> � CITY 1 STATE ZIP (, U37_ <br /> CONTRACTOR PHONE: ZS3 E,'O�/ los-6 CONTRACTOR� EMAIL: �Q�- NZI <br /> CONTRACTOR LIC.#(REQUIRED):f) `V 3 t 1pCITY OF EVERETT BUSINESS LIC.#(REQUIRED): 31493 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �,� CONTACT PHONE: <br /> jtu& v\,t ✓ U ry\ /t,I CONTACT EMAIL: <br /> AGREEMENT I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances 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 /> A% PERMIT# <br /> A LA - II ,36 I (0 E C 0c2 - 00 � <br /> Owner/Authorized • ent Signature Date (Revised 9/23/2016) <br />