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41577- 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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT� /SIT�E�INFORMATION <br /> PROJECT ADDRESS: i �l r(��� �KiV ✓✓'� <br /> 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: 0 COMMERCIAL <br /> USE OF BUILDING: 516 r 5-7-02A7 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ . /1/ if(JO, .06 <br /> NUMBER OF DEVICES (if low voltage): /171 <br /> FIRE ALARM? ❑YES )-NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: A/)1(RA 5 '7)/ 5"7: �4/2 ;;>2,Z9 <br /> i - Ste' s L,4g o 2 ft),D /4J62 6 <br /> CONTACT INFORMATION <br /> OWNER NAME: 1, 2. ...",-7611 .1 /c 7 A / ? n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET/O97' ' DPG 6Uef5Y& / (�/Jj <br /> r / STATE `4Y'4 ZIP p✓s <br /> OWNER PHONE: 4'z6 L)'1 573041 OWNER EMAIL: <br /> CONTRACTOR <br /> fal2 <br /> ._ ... lit/ S c r C <br /> NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> o_6 e/5 &.) <br /> Jj <br /> `t 1 f <br /> crry /Gle.pc(i / 7 STATE (t./173 <br /> _ ZIP��gj 7z <br /> CONTRACTOR PHONE:. -5 /96t 734( CONTRACTOR EMAIL:M4/4_ 1Ar20/Z �r�1 iAS <br /> CONTRACTOR LIC.#(REQUIRED): 4J1 N?O <br /> pi I" CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(057 y I q <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> / <br /> CONTACT NAME: CONTACT PHONE: n -65 "6r <br /> CONTACT EMAIL: 77/2145) Me/U t rei-/tel�/1/, b7. <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 /> l`6 PERMIT# <br /> -!- t2`s� EDI (Q 12- E309- <br /> Own, <br /> 9- <br /> Own' /Aut •rized Agent Signature Date (Revised 10/12/2015) <br />