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S • <br /> a7- ELECTRICAL 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 13' 1'E u twa <br /> BUILDING AREA(if residential, new constructio , remodel r addition) 7 2'p SF <br /> BUILDING TYPE: XSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: 5 F'p, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 4 NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: 12.1EisL3 'L c_.N , 'Noor, OWN Mi 4 L, p k).17Ek fit-{ <br /> e 1=-)raw CV <br /> CONTACT INFORMATION <br /> OWNER NAME: J .Y N SIV i 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET SAtpa. <br /> CITY STATE ZIP <br /> OWNER PHONE: 3 a3 (2)`Q— 0 (p00 OWNER EMAIL: <br /> CONTRACTOR NAME: 1\-1 lV t Til N <br /> CONTRACTOR ADDRESS: STREET 3 S,5. Ss 11 (2( .37 <br /> CITY (VCRfET STATE GOjA ZIP 9.8 ZO/ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: MLL,%(t b &.-4(c(L.,, <br /> CL.00 ; LIC. <br /> CONTRACTOR LIC.#(REQUIRED): CLAN' CITY OF EVERETT BUSINESS #(REQUIRED):): e)3p C 3`f <br /> PRIMARY CONTACT: 0 OWNER IN CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: `?A5 3 ct- <br /> l iC- M Ct>t���'�/ CONTACT EMAIL: SANE <br /> AGREEMENT T hereby certify that/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 /> 1UU <br /> PERMIT# <br /> O����- �� _ 3 - 17 El� p �- p2Z <br /> t orized Agent Sig�_iat e Date (Revised 10/12/2015) <br />