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• <br /> 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 I (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Z ( e.-1-6A0c ic\-Art. <br /> BUILDING AREA(if residential, new construction, remodel, or addition) tOOQ SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS. 5a-COMMERCIAL <br /> USE OF BUILDING: LAW <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 5, 00 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES IkNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: e 280 Sex*c.&.. 0,rt,r pvt.o.ek s: KA-i„ <br /> 4 6,--60 04- 100 0 . re tl s41,6( <br /> CONTACT INFORMATION <br /> OWNER NAME: S s TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / W1/44.4-yvk 0 ft_ <br /> CITY J tE (A./ 4 z F' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 13,0,. \I';‘t.(.3 1<-c--4-r-is`— <br /> CONTRACTOR ADDRESS: STREET -toy id, gr 4 . <br /> CIT( rri4DA) STAIR WA. Z,3 <br /> CONTRACTOR PHONE:36 — 5-3 s- 'CONTRACTOR EMAIL: calk Ff <br /> CONTRACTOR LIC.rr(REQUIRED);(34*tori L.. 54. _CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 645-4iZjo 5? <br /> PRIMARY CONTACT: 0 OWNER V-r ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3 0 s--36- <br /> iloc it- 4-"As - - CONTACT EMAIL: ah <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 <br /> comply with the State Contractors Law 18,27 RCW and 295,200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 6 E )4)-- 2,\O <br /> Oviin r/A horized Agent Signature Date (Revised 10/1Z'2015) <br />