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lik <br /> 1L.E CCTRICAL PERI 1111-1 Ar I✓LllCATiO <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> P OJIECT SITE E INFORMATIO <br /> PROJECT ADDRESS: f2or-A—64_G-veArf M of-lntip` I2o5i C1ra. {1 vka. u / Dock. 4 5.2. <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF / <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: it[COMMERCIAL <br /> USE OF BUILDING: 5OQ.kvl0 Vrje.. <br /> ELECTRICAL APIPLICATIoOM I11t91F'Oi^ <br /> CONTRACT PRICE OF WORK:$ '300•''0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ANO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): v a '.-&_ <br /> DESCRIPTION OF WORK: <br /> iZ ewM.o.t-9— ex ba 4.e. CAA/LA ,s 14 4-irnn-eov— <br /> S LA:Are, eauter �? - l) Co r-4 <br /> C.•,NTACT IlNF.•,RATIIOId.. <br /> OWNER NAME: Twp 0QN/t 5 TENANT NAME(If Commercial): s <br /> OWNER MAILING ADDRESS: STREET YO 3 X 1 I D .- r <br /> COY ciwthA STATE WA' ZIP'5Z3(0 <br /> OWNER PHONE:42,5- 330 ' 07 7 3 OWNER EMAIL: N14 <br /> CONTRACTOR NAME: ( -M �(ed G CO <br /> CONTRACTOR ADDRESS: STREET $2)00 60-LX Ei-&tJwy 54-e. 5o3 <br /> CITY (2'( ti eVel, STATE ��//�-� ZIP 0180 t 2- <br /> CONTRACTOR PHONE:Lf�5` 2j - (q 0 Z CONTRACTOR EMAIL: MfP14(i(y 1('l f�L.Co►.vt <br /> CONTRACTOR LIC.#(REQUIRED): keL....gte016,j CITY OF EVERETT BUSINESS LIC.#(RERUIRED):0544 514 3 <br /> PRIMARY CONTACT: ❑OWNER ig.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.. ?sei- 1R oz <br /> (144166-WC0 f CONTACT EMAIL: i'UtSPfi(Lleti 1(7 p /41-.00144 <br /> AGRFFMENT.T hereby certify that I have read and examined this application and know the same to be true and direct 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 WAG. <br /> City of Everett Official Use Only <br /> FEE f <br /> (J '(-0•11--- <br /> PERMIT S#} <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />