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41 pvis. <br /> ----1 <br /> OLT 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 )everetteps©everettwaVl vvvvw.everettwa.govipermits <br /> PROJECT SITE INFORMATION <br /> •-) - -,-, i• - - 1,-- _ ,.,,,,—*1- <br /> PROJECT ADDRESS: 3,6) ... - ‘.a N.Ail) f::› f ,-.),(1- c.x.c ti 6,_,:',H k N <br /> ) <br /> BUILDING AREA(if residential,new construction remodel - addition) t--- it ,e' SF I 2 L1 ,6k <br /> BUILDING TYPE: 0 SFR-DETACHED XSFR ATTACHED 0 DUPLEX 0 MULTI FAMILY #OF UNITS: 0 COMMERCIAL <br /> - - - <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> _ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ,,,t6 NO <br /> ,.. <br /> ASSOCIATED BUILDING PERMIT#(if app1licable): <br /> 1, <br /> DESCRIPTION OF WORK: 1 4-r40-0-0. <br /> CONTACT INFORMATION <br /> OWNER NAME: /II ;1 v:L.,-0 0 1,,,,.....1 -.) TENANT NAME(If Commercial): - -- <br /> OWNER MAILING ADDRESS: STREET 705 <br /> a4-7 -d 11 CITY STATE Cie'x <br /> j 77 <br /> OWNER PHONE: OWNER EMAIL: <br /> 'CONTRACTOR NAME: Milne Electric Inc. <br /> CONTRACTOR ADDRESS: STREET 14582 172nd DR SE <br /> - .. <br /> cm{ Monroe STATE WA ZIP 98272 <br /> CONTRACTOR PHONE: 360-863-9617 EXT#228 CONTRACTOR EMAIL: Duane.Leamer@Milneelectric.com <br /> '..CONTRACTOR LIC.#(REQUIRED): MILNEEI101PN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 031702 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR El OTHER(Please Specify) SERVICE MANAGER <br /> CONTACT NAME: CONTACT PHONE: 206-595-9243 <br /> DUANE LEAMER CONTACT EMAIL: DUANE.LEAMER@MILNEELECTRIC.COM <br /> AGREEMENT:Thereby certify that I have read and examined this application and know the same to be true and correct. Al/provisions of laws and ordinances governing this <br /> type of work wi//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/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 /> FEE oe <br /> (0 0 <br /> , <br /> PERMIT# <br /> E 1-70q - 2 .? <br /> thorized Agent Sign. ure Date (Revised 10/12/2015) <br /> • <br />