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ECTRICAL PERMIT AP !CATION <br /> Ak" 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 f www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: S ei,2ce X L C1-1 (At ZB rav-c.ka Po BUILDING <br /> - <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: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 60C) <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 5110 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> C \N2..ri Ct-v-e-x-a"& Cine" .Q.-%re\r›C.\\-(2 <br /> LkiZ CAQ-1,..Lo (A "ckteAL,Ll' <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 00o..c,LA , aLe <br /> CONTRACTOR ADDRESS: STREET '51ACA. \.'a•C) <br /> CITY o STATE t„,13Pr. zip CALI <br /> CONTRACTOR PHONE: QSZ.sgq_Itait CONTRACTOR EMAIL: 0y0 cA)oLeN,ex ck,, t, k‘. <br /> CONTRACTOR LIC.CREQUIRED):(3ç )f C4G Cat:a E.Cr CITY OF EVERETT BUSINESS LIC.*(REQUIRED): 645 II I <br /> PRIMARY CONTACT: 0 OWNER LWCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a5 5,evt LA. ‘„,‘ <br /> Rayon char\(A-INs) CONTACT EMAIL: at:Lyon e caAt, eve. \AL <br /> AGREEMENT:Thereby certify that!have read and examined this application end know the same to be true and correct All provisions of laws end 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!em authorized by the owner of this property to perform the work for which application is made end <br /> comply with the State Contractors Law 16.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> • <br /> FEE <br /> PERMIT# <br /> -01.40,16 <br /> Co • E 1 ,o0(0— I (d)) <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />