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RECTRICAL PERMIT APOPICATION <br /> I�►' 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 /> Olt PROJECT SITE INFORMATION ` <br /> PROJECT ADDRESS: ..(9-30-c 3 62T Aue_ W Cvee � Bu i tt< <br /> BUILDING AREA(if residential,new construction,remodel,or addition) a2_, 15-6 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: I OMMERCIAL <br /> USE OF BUILDING: WctrthI xJS< / <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �f� 0 <br /> NUMBER OF DEVICES(if low voltage): 67 <br /> FIRE ALARM? OYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): i <br /> DESCRIPTION OF WORK: LtrkSkr J , 1-cC,t� Sk-CCJo t✓5 G 5 s 4'(N. 1z7;� <br /> CONTACT INFORMATION <br /> OWNER NAME: V)&it(1.C., dttik TENANT NAME(If Commercial): rU <br /> OWNER MAILING ADDRESS: STREET F---04-‘- Den.c c,Ur,,vt 5T �v 5-C, (} �t <br /> CITY 6 ,4‘.4-(-A.12-.- STATE (A)k ZAP �LSL S t" <br /> OWNER PHONE: s G, ` 3S -3841 OWNER EMAIL: <br /> CONTRACTOR NAME: 0\,5-e/1 E c,(-r L <br /> CONTRACTOR ADDRESS: STREET a5 VJCAstevtfy f C 1 Avg 5 *it / <br /> cry ( � <br /> a- STATE jA- ZIP <br /> CONTRACTOR PHONE:,2.s3 -67.2-I`Loc.... CONTRACTOR EMAIL:j v S I'i✓lc fe(S to•SGC(ted r t, <br /> CONTRACTOR LIC.#(REQUIRED): S Ski St'13 P CITY OF EVERETT BUSINESS LIC.#(REQUIRED):04(0/0 01.. <br /> PRIMARY CONTACT: 0 OWNER ISirONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a 53 C Cf 0 S" <br /> i k3 E &I (ln 1 CONTACT EMAIL:el L, s, �else c't <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and ct. 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 lam 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 <br /> 5/6 <br /> PERMIT# <br /> E f(©D D `E3 <br /> nerlAut rized Agent Signature Date (Revised 10/12/2015) <br />