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4:77 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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION/ /� <br /> PROJECT ADDRESS: 5202 s ear vl (/l K5.--(- 1' r l p �vere�� V V h - 1�zo <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: S t ri Q)/e (fro f /'J CTOrP-/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /1 �- 010 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES :VO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / <br /> DESCRIPTION OF WORK: /00 OIVVI P ,()a��1 �iV la-`' <br /> //,�,-, /� ,/ CONTACT INFORMATION <br /> OWNER NAME: 136 YC/t/'O. V/UOS c o / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /2��/2 /l$ t7�"I `5± 71 1/1/4 <br /> ^l Hn <br /> /�/ 17 <br /> CITY �V ri/ ' / / STATE ✓ �/ J ZIP 1?2.0-3 <br /> OWNER PHONE: (A//�) OWNER EMAIL//\ /A <br /> CONTRACTOR NAME: I b 6 C'CC I COJ/seKVJ Ce , inc„. <br /> CONTRACTOR ADDRESS: STREET ' /I7-th )2 Si <br /> CITY L/ STATE it.)/4- <br /> CONTRACTOR PHONE: (4I2 )23`'- "3 CONTRACTOR EMAIL: // (7SC /1,77 h&-/J e/p/Z-IPP v9/lCL/J.J(C�/a <br /> v <br /> i/ <br /> CONTRACTOR LIC.#(REQUIRED): I N UCS. /2 670 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 91-1-/-71//67 <br /> PRIMARY CONTACT: 0 OWNER --t -CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Kz,/c1.1 CONTACT PHONE:('L1Zs-)7jQ —�Y0 .1CONTACT EMAIL: / j�.e-e V'e Il /�Ci <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and co t. All provisions of>aws and ordi an es 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 authorized 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E Itc2 - d0 <br /> Owner/Authq(ri.-. Agent S gnature ,/ / Da e� (Revised 9/23/2016) <br /> / <br />