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• <br /> ELECTRICAL PERMIT AP LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257�-8857 � (E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> RR+OJ��Cfi SI"�"� 11+NF'�RMATI�N�1 <br /> p�CIJECT ADDRESS: F7o� ttarde,<�r. Rd <br /> 13UILDING AREA(if residential, new construction,remodel,or�ticiiEion)' 1�� SF <br /> �Ul1.C11NCi TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: I�COMMERCIAL <br /> USEOFBUILDING: Manufacturinq <br /> E1.E�TFtMCAL A�"pLt�ATt+C'!�1 IN�t}R�ATtC�N <br /> CONTRACT PRICE OF WORK: $ ' , � <br /> NUMBER OF DEVICES if low volla e): <br /> FIRE ALARM? ❑YES ❑NO <br /> A�StJC1ATED BUILDING PERMIT# if a lic�b{e ; <br /> C3ESCRIPTION OF WORK: i�stall 100a Satety Switcki for tesring equipment <br /> C�NTACT lNFORMATION <br /> OWNER NAME: vame as above TENANT NAME(If Commercial): umbra Cusc i netti <br /> OWNER MAILWG ADDRESS: srReEr <br /> CITY STATE ��P <br /> OWNER PHONE: 4z`-� `�05.3500 OWNER EMAIL: <br /> CONTRACTOR NAME: Valley Electric Co of �1t. Vernon <br /> CONTRACTORADDRESS: srReeT t7C0 Merrill Creek earkway <br /> GTY f,vere�t STATE WA ZI? 4g��� <br /> CONTRACTORPHONE: 425.40�.Od"32 CONTRACTOREMAIL: permits@veLectric com <br /> CArt��'RA�TClR LIC.#(i���UlRE�1�: VAI.,LEEi4iNA CJ'TY OF EVERETT BUSINESS LIC.#�Fth�1�1I�ED). o7�55e <br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �abe coan CONTACT PHONE: 425.322 � .�;���:; <br /> C�NTACTEMAIL: Gabec@velectric.com <br /> AGREEMENT:T hereby certify thet!have read and examined this applicafion and know the same to be true and correcf. Ali provisions of laws and ordinances governing this <br /> type of work will be completed whether speciiied herein or not. The granfing oi a permit does not presume to give authority to violate or cancel the provrsions of any other state or <br /> lor,el law regulating construction or the performance of cons�ruction. That I am authorized by the owner of fhis property lo perform the work for which app/ication is made end! <br /> comply with the Stete Contractors Law 18.27 RCW and 296.200 WAC. <br /> t"Idy of Everett Official Use pnt}j <br /> FEE <br /> �� 2 �� C� <br /> � ��, PERMIT# <br /> � � �.�._ E �.l�aq - I� C� <br /> � � <br /> '.� � .i � r`� ,'..,.a'� t � '1, ....... ..... <br /> "'� Revised 10/12/2015 <br /> Awner(Authprizetf Agent Signature Date ( ) <br />