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00 <br /> ELECTRICAL <br /> ECTRI AL <br /> C PERMIT APPLICATION <br /> 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: i-II I CAL j:CQNBA S-Y <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: "PAR-1-1 NC,. G.Aft,Ae.E <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): 7 <br /> FIRE ALARM? '%YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: i"STAe-L- F12E ALAiz 9-L —JOR 2-SLAt-I- S'YSTL-r— <br /> CONTACT INFORMATION <br /> OWNER NAME: -Ta)p t3 i-v-jWSgA0 eoL4,Sa -*_ TENANT NAME(If Commercial): 'i- Y ; r .A94)N -fZ, Gta 0.r S. <br /> OWNER MAILING ADDRESS: STREET e8o?— AVE n <br /> cITY AVSf2-*- + STATE Ill ZIP -113 ' <br /> OWNER PHONE: WT-4' 320 (al ? OWNER EMAIL:51WE's'.D)PV,,.D QZ"rtL•VDv <br /> CONTRACTOR NAME: 3� R r-ixra Pme, SF.Lv21i`/ 41_C_ <br /> CONTRACTOR ADDRESS: STREET RV Sty, 3 <br /> CITY A)1ZL-)hjC^j0/v STATE WA ZIP 907-Z3 <br /> CONTRACTOR PHONE: H-Z. 24" CONTRACTOR EMAIL: S�F-Gi: P_13Nh3 F-)(Zr <br /> CONTRACTOR LIC.#(REQUIRED): i3)',Vit( 4'494-) CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0555 i <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: !y 25 zLtq l / f <br /> ':5'ScY f' 3RuS6A2b CONTACT EMAIL: T1E`F @-8/Y 14 F I"-.cor,, <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 /> k L�--� _ 5 <br /> PERMIT# <br /> Q3 <br /> Owner/Authorized Agent Signature Date (Revised 1 071 272 0 1 5) <br />