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� • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q1 <br /> (P)425-257-8810 � FAX 425-257-8857 � {E)everetteps@everettwa.gav � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJEC7 ADDRESS:4gZO EV@C' reen Wa South Everett, 1111A 98203 <br /> BUILDING AREA(if residential,new canstruction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑S�F2-A7TACHED ❑ QUPLEX ❑MUL71-FAMIi.Y-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDlNG: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTF2ACT PRICE OF WC7RK:$ 2000.00 <br /> NUMBER OF DEVICES if low valta e): <br /> FIRE ALARM? ❑YES C�NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRtPTiON OF WORK: Replacin lamps and ballast thrau hout the store as needed. <br /> � CONTACT INFORMATION <br /> OWNER NAME:Stc"3 �@S TENAN7 NAME If Commeraial: l�is <br /> QWNER MAILIN6 ADpRESS: srReer 500 Staples D� <br /> �,�, Framingham STA� MA z,P 01702 <br /> awNea PHONE: 1-503-253-5300 OWNER EMAIL: <br /> CON7RACTOR NAME:WeSt COaSt LI htin & Ener y, INC. <br /> GONTRACT�R ADDRESS: sraeeT�$5�J� MIIlfI10fi1 St <br /> �,n Lake Elsinore S'ATE CA z,F 92530 <br /> CONTRAC70R PHONE:95�-296-0680 CONTRACTOR EMAIL: kf�y�W�5tCO�Stll�htlll��llCJEf1G'f�y.GOtl'I <br /> CONTf2ACTOR LIC.#(REC�UIRED;: .,(�'���J;oCi'i � �`� �� CITY OF EVERETT BU51NES5 LIC.#(REQUIRED):047�E�7� <br /> PRIMARY CANTACT: ❑pWNER 0 CONTRAGTOR �OTHER(Please Specify) <br /> CONTACT NAME: CQNTACT PHdNE: C���_2g�'j_�(`j${j <br /> Karen J. Fay CQN7ACT EMAiI:��rpE �S abOV@ <br /> AGREEMENT:f hereby cerfify lhat 1 hsve reed and examined this app/rcation and know the same to be true and cor�ect. Atl provisions of laws and ordinances governing this type <br /> of work wiN be�omptefed whether specrfied hereln or noL The grantinq of a permrt does not presumQ Co grvs authorfry to violafe or cancel fhe pravisions of any othe�state or <br /> local law reguloting construction or fhe peiformanee of construction. That f am authorized by the owner of this property to perform the work for which appfication is made and! <br /> comply wifh the State Canfractors Law t8.27 RCW and 296.200 WAC. <br /> Crfy of Everett Officra!Use Only <br /> PERMIT# <br /> a-.�-r E '�� � �-- 15 `� <br /> Owner/Authorized A nt S gnature Date (Revised 9/23/201fi) <br />