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EECTRICAL PERMIT APNICATION <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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �� (0 <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: <br /> USE OF BUILDING: XCOMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $•/ 7 Z ©o <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Q C{ �, �L ; + ( rt e r <br /> CONTACT INFORMATION pp <br /> OWNER NAME: TENANT NAME(If Commercial): C.- <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Cq c—\;11,1 E.YY" <br /> CONTRACTOR ADDRESS: STREET I v (� ' ,\ Vr. H. 3 <br /> CITY (�'1 i.L,Y fit' ✓ I I STATE 'kJ'kJA ZIP 9`'.)3 1-f <br /> O <br /> CONTRACTOR PHONE: 3cCO (Deo 3 5i(-13 5 CONTRACTOR EMAIL: (1,,^nc-,..nd cL 505-v'• €M <br /> CONTRACTOR LIC.#(REQUIRED): U AtZ VZ L`-L q ?c S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0 X91 O <br /> PRIMARY CONTACT: 0 OWNER of CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3 G5 3 9,1 35 <br /> o`y\C(o 140:,'11 t'tir`.. i- CONTACT EMAIL: (,.nc::.I�lc, c 9 cv-n,.,ihen} •Lcm <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 Use Only <br /> FEE <br /> 94g <br /> PERMIT# <br /> /(21/71 JA/ 6/0 ?//& E <br /> Owner/Authorized Agent Signature Date <br /> (Revised 10/12/2015) <br />