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47577 ECTRICAL PERMIT AF _ICATION <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: 3 c-A 4 e- 1/4./e re -4-1- <br /> BUILDING <br /> ,-?r 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: .3/41 OMMERCIAL <br /> USE OF BUILDING: WeiC-el SAO 4L�- <br /> ((ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $cZ (JOC) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES JNO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: Pte) V OO /4 \1 <br /> Ser V-rce_ \c fee-&_ -J U � Cc <br /> 1 n 5 (�.114.1-_;h 7 "\c (Y .S _ U.,�mss ;.�, ( <br /> CONTACT INFORMATION <br /> OWNER NAME: Pin 4. 0evev.,ec, TENANT NAME(If Commercial): cC'-S a Li <br /> OWNER MAILING ADDRESS: STREET Co e¢() t r f f aerryS U <br /> c'TY . 1 e&A-L(2_ STATE t ZIP 10 °U <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1` er) <br /> CONTRACTOR ADDRESS: STREET 3.2.r AJ e h N. <br /> CITY Vv./11- STATE INJ�- ZIP /gU <br /> CONTRACTOR PHONE:,2 S y0 CONTRACTOR EMAIL:_( I-01r/1 e k Sen c to - <br /> CONTRACTOR LIC.#(REQUIRED):ULS EN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:_2 5 _ <br /> . 0.5 Vin. 6-1-rov‘Wc.ry CONTACT EMAIL:, , <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 /> PERMIT# <br /> t ( 5-1( OC) <br /> % signatu;e Date (Revised 10/12/2015) <br />