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LECTRICAL PERMIT AP ,ICATION <br /> ETT 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 l www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 11 OH E 1 5 <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: Lc ( , 14j --et <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ '')(j) (J0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: G? ( "t j O (\J. > LA..)(,t <br /> CONTACT INFORMATION <br /> OWNER NAME:'_O(jk ?6 c S TENANT NAME(If Commercial): 4 , LIQ{- l L} <br /> OWNER MAILING ADDRESS: STREET pc, <br /> CITY 1 Vl 60, (,t STATE i.jJ() ZIP c78-civ T <br /> OWNER PHONE: OWNER EMAIL: I <br /> CONTRACTOR NAME: (NA t y ( rjI ;Y- ,- I°CU-e( <br /> CONTRACTOR ADDRESS: STREET _(2t10 H-w 1 gel S <br /> CITY la NO t y-ern(r STATE L( ZIP 7� <br /> CONTRACTOR PHONE: jt;(U• 1,1 2.1-1-I 3 j CONTRACTOR EMAIL: `-)fe-(--L 1li f yY),i,/P( ti <br /> CONTRACTOR LIC.#(REQUIRED):MF\1 LS(,C 17 L11 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 8 <br /> PRIMARY CONTACT: 0 OWNER J CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: - 00-(4ZL1 - 13 a .S <br /> I � / <br /> e V� 1 A.Gf U l CONTACT EMAIL: 't� t ✓�1 CL✓ t},v Li'e( '>j qv) . Le, Y <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 /> 050 <br /> °/ <br /> PERMIT# <br /> CCI\ILIA1),(1( aff <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />