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� • <br /> ELECTR)�AL PERMIT APPLICATION <br /> GITY OF EVERETT PERMIT SERVICES <br /> 32Q0�EDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-25'�-8857 � (E}everefteps@�verettwa.gov ( www,everettwa,govfpermiks <br /> (pl� PRflJECT SITE INFORMATION <br /> PROJECTADDRESS: �'C�S�vV@St Marlrle VI�W Df., Everett, WA, 98201 <br /> BUILDING AREA(if residential,new construction,remodei,or addition} SF <br /> BUtLDING TYPE: ❑5FR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: (Y�COMMERCIAI <br /> usE oF Bu��o�N�: Construction Tem orar Power <br /> ELECTRiCAI. APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2,500 ' <br /> NUMBER OF DEVtCES (if low voltage). I <br /> � <br /> FIRE ALARM? ❑YES 0 NO ' <br /> ASSOCIATED BUILDING RERMIT# if applicable : <br /> DESCRIPTION OF WORK; 200A S@CV1CL'f�t'�dC1Stt'UCti0t1 Tf al�@t'S <br /> CONTACT MNFORMATION <br /> OWNER NAME:Itlt@t�W2St COI"1St1"UCtlOtl TENANT NAME(If Commercial : <br /> QWNER MAILING ADDRESS: sTReer 6O9 N HII) gIVC� <br /> �,r,, Burlington S7'ATE v�„ Z�P 98233 <br /> owrv�R PHorvE: 360-757-7574 owrr�R�Mc,i�:danaorbe@interwest.biz <br /> coNTRacTOR NAMe: Electric West <br /> CONTRAC70RA�DRESS: srrteEr�17 N 6th Street <br /> �,n Mount Vernon STATE vyA Z,P 98273 <br /> CONTRACTOR PNONE: 3�0-4�9-9375 GONTRACTOR EINAtL: brUC10�@I@CtPIC-WBSt.GOC11 <br /> CONTRAGTOR LIC.#(REqUIRED}: ELEGTWIO�O.�'I CITY OF EVERETT BUSINESS UC.#{REQUlREb}:O3'4$H9 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTQE� ❑QTH�R{Please Specify) & <br /> GON7AGT NAME: GUNTAGT PHON�: 3FQ-4�9_Q37'$ <br /> Bruno Padilla c�NrAcr Enn�v�:bruno@electric-west.com <br /> RGREEMEN7.�i t�ereby ceni/y thnt t have read and exami�ied this appticatian and know tha same fo be irue and corract Al/provisions of laws and nrdinances gouerning this ty�e <br /> of v✓ork wilt be completed whetlier speelfred hsrein or not. Ttie grandrZq of e perroA�'oes not presume to g(ve autMoiaiy to vlola2e or cancal fhe pravisicsns nf any all�er state or <br /> local law�egulating construct�on or lhe performance of consfruction. That 1 aret authorized by the owner o/this pmparty to pedonn the work for whkh application is made and I <br /> comply wfth!he State Contractors Law 9II.27 RC W and 296.24D WAC. <br /> � <br /> City of Everett Ofiicial Use Uniy <br /> t <br /> ' �`' PERMIT# <br /> ''f��F �+` �� # , `� <br /> � � ,�� rc:� �`���°�9` � j '� <br /> � <br /> d a ,<- ...,o�° � z � s� „ � �� � / �,: <br /> $� ( <br /> C�n�er/Authorized Agent�gnature Date {Revised 9123/2016) <br /> � <br /> � <br />