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OLT ELECTRICAL PERMIT APPCATION <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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Q,:..C ) t 6:t " Ai , C�� _ve <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX -I t 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: L c: ,Y�'y\�' \�C'.�-c \ , Y �' Tc—� 0 r <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ £,c) 3 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? . :11ES 0 NO e.1 <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: V"1 61-4,`� G ��G� ` .„ <br /> CONTACT INFORMATION <br /> OWNER NAME: l3 es'Ire_A. W+UC9J S TENANT NAME(If Commercial): a,:.f' k,( O:Jc(, <br /> OWNER MAILING ADDRESS: STREET =}'U 5 0 eAT v�`` `— �.' �j 1 i� �.,� G�{)C7 <br /> CITY 'S L'"�.� STATE VLA, ZIP (IEJ('067 <br /> OWNER PHONE: ,z(2)(z, -76a OWNER EMAIL: <br /> CONTRACTOR NAME: 0 5z rl C-7 L'_.CA-�'L <br /> CONTRACTOR ADDRESS: STREET c.;" \ `i,:,s'n .ntd� t / _. �� cik. <br /> CITY `' Z n k STATE (/ }1c ZIP`7e C' <br /> CONTRACTOR PHONE:045 5 -j-;-Liz— VIC'S CONTRACTOR EMAIL:, ;1t.7ej <br /> CONTRACTOR LIC.#(REQUIRED):(J L 5 7,(L.) vc-1,3 I CITY OF EVERETT BUSINESS LIC.#(REQUIRED): CY—F(0(0 <br /> PRIMARY CONTACT: 0 OWNER 4CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: _;2cj'3 `'-Z —/ c70 5` <br /> / r- CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the saMel to be true and c rrect. All 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 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 /> 012,E <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ct')/ 1 ( E no3 <br /> caner/Aut or'zed Agen(Signature Date (Revised 9/23/2016) <br />