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grr SECTRICAL PERMIT AILICATION <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: C6 C5(:=)3 414 At- SE-- <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED%SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: C fi2— <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 4.15c� <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YESNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: AM G/lLGurr ,p/L Nj/.-1 wen-44( 't -r hi <br /> LaMfr) <br /> CONTACT INFORMATION <br /> OWNER NAME: LOMAJ/-J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET TIP:,3 ti.f14 AL- SE <br /> CITY G STATE lAiA ZIP 111.0 <br /> OWNER PHONE: 1-12..S-353 --2473 OWNER� � EMAIL: <br /> CONTRACTOR NAME: ci(4/fL A/AJUI. ri1✓'c/w� TA- f -s <br /> CONTRACTOR ADDRESS: STREET 2-24 J',�Z- NO S� 57,"? <br /> CITY 6��� STATE W A ZIP 1/0)12-- <br /> CONTRACTOR <br /> 'K 1!--CONTRACTOR PHONE: £ZS_1/gel—114,0 CONTRACTOR EMAIL: sb(NDaNtrC .-4„Gy 2. .GOP <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQ IRED): <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f' ! L-0/4-1--- <br /> L CONTACT PHONE: 'Z�"— 2-SS' 3-21 <br /> I�G� (N CONTACT EMAIL: <br /> AGREEMENT:I 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 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 /> C <br /> /-1-1 E ti Ro9 . 3 5 <br /> Owner/Authorize, Agent 'g ature Date (Revised 9/23/2016) <br />