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12/22/2017 11 : 43 #3049 P. 001/001 <br /> • ei <br /> ELECTRICAL PERMIT APPLICATION <br /> ie.„,,fr,IP:=, <br /> CITY OF EVERETT PERMIT SERVICES <br /> A11`4 / 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps(aeverettwagov I www•everettwa.gov/permits <br /> PROJCC'T>g17EINFORMATION .� ... <br /> PROJECT ADDRESS: , 71 : '• <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> "BUILDING <br /> USE OF BUDDING: .4.4-4.44.4-1, .—....44-1.•-0--6 <br /> gLECTRICAL APPLICATION INFORMATION . • . . <br /> CONTRACT <br /> PRICE OF WORK:$ (}(') <br /> NUMBER OF DEVICES (if low volt�.le): <br /> FIRE ALARM? LI YES ❑NO ' <br /> ASSOCIATED BUILDING PERMIT# if e••Iicable : r — <br /> DESCRIPTION OF WORK: A . ,�I l U � , ' A. i L ,a/.�' <br /> / %[J■1 3 Ggi/ <br /> CONTACT INFORMATION ' <br /> OWNER NAME: kr f 1 ' TENANT NAME If Commercial : <br /> OWNER MAILING ADDRESS: s-rna-r '3 (6 , At /L. ,I <br /> TYf +r ,. +.7 <br /> CITY ' R'. r STATE ZIP i I <br /> ii <br /> OWNER PHONE: ...�,I I jr OWNER EMAIL: <br /> CONTRACTOR NAME: A • La. -C1../.,,, f R, <br /> J <br /> 1 <br /> CONTRACTOR ADDRESS: sir r�i O . .,. rT e •i I <br /> STATE q ZIP 1/ .•a: <br /> CONTRACTOR PHONE: /_y 'nF` 2 CONTRACTOR EMAIL: f <br /> CONTRACTOR LIC. • REQUIRE°: ' .• CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0! , <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) ,D1)a -' <br /> CONTACT NAME: CONTACT PHONE: y.2J ,22 J/ ) <br /> 0 O m 1) OC-7 44. CONTACT EMAIL: <br /> AGREEMENT;I hereby codify that I have read and examined this application end know the same to be true and correct. Ail provisions of laws and ordinances governing this type <br /> 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 authorivx1 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 206.200 WAC. <br /> City of Everett Official Use Only <br /> / PERMIT# <br /> a 04 E r--1---`T2_. r <br /> 1 -3-- <br /> o9' or/Authorized Agent Signature Data (Revised 8/232016) <br />