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I CTRICAL PERMIT AP_ICATION <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: / d p ' _53`eee. r <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: 5e,,,w4e,- 119G 00 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /0„, DOC) <br /> NUMBER OF DEVICES (if low voltage): p ,.� ,tib,- ', / t/ a4/44,s, 64•t - <br /> FIRE ALARM? 0 YES , 1O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �Q� � �/J ,210 vo 4 e/,... <br /> gooz77 ?.' if/ <br /> CONTACT INFORMATION <br /> OWNER NAME: �ly o/f,j ,,•7 f TENANT NAME(If Commercial): Se Ad <br /> OWNER MAILING ADDRESS: STREET 3200 <br /> CITY v STATE y/4 ZIP jir.2,a <br /> OWNER PHONE: 4/2S" ZS-0 .— /J 'Q OWNER EMAIL: c4-iar.r/f © .et>.zrmf7� <br /> X <br /> CONTRACTOR NAME: Z /y S .� <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:T 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 <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 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 Us,Only <br /> FEE <br /> PERMIT# <br /> ;-23;07 <br /> EC) <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />