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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INF�RMATlON ' <br /> PROJECTADDRESS: ��ioZ. SE EvE2�-r-i' vmf'IL.L W�i STE 13 <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: GII COMMERCIAL <br /> USE OF BUILDING: Q — $vSIN�SS <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ f d � <br /> NUMBER OF DEVICES if low volta e : V Fw <br /> FIRE ALARM? YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if ap licable : <br /> DESCRIPTION OF WORK: Rk"ptqc� ►N PE il� tA CoN tJ <br /> CONTACT INFORMATION <br /> OWNER NAME: �.q � �}� g TENANT NAME(If Commercial): e.�4 f17N�5 <br /> OWNER MAILING ADDRESS: srReeT 1�i02 SE �V ?T }''�111. WA -� )3 <br /> CITY �.�f�fZ�'R"j STATE ZIP 9 Zv <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (3 � H F' — SEGv�t LL�.. <br /> CONTRACTOR ADDRESS: srReer � on g �� <br /> CITY � "f STATE W ZIP CJ�ZZ <br /> CONTRACTOR PHONE: '-�2S Zy y ��tyS CONTRACTOR EMAIL: 5EF C N F IRE C.o <br /> CONTRACTOR LIC.#(REG2UIRED): j3HF►P H F$�jZ. tn� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OS5(o97 <br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: yZ,s 2�tH ! <br /> 'S�Fp $��S,cy� CONTACT EMAIL: �-�F� � f�NN R�' .Cc�1'h <br /> AGREEMENT:T hereby certi(y 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 comp/eted whethe�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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �-C� �� <br /> �----� PERMIT# <br /> / /' .% <br /> � !.-. - E �� � I -2�� <br /> Own r/Authorized Agent Signature Date (Revised 10/ /2015) <br /> ��Z°� ez <br />