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477 ELECTRICAL PERMIT APPLICATION <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: ¶(p 3. OV Q c3C"..02.0 V1/49 ail <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: IgCOMMERCIAL <br /> USE OF BUILDING: O t t C_A a vt 9 1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3 rlj,00 <br /> NUMBER OF DEVICES(if low voltage): y <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ��" <br /> DESCRIPTION OF WORK: In.c+LLI 1 fl Q_u3 5`‘3 n S c h-Yv Le-1) <br /> CONTACT INFORMATION <br /> OWNER NAME: /1"14....iv- `, sas n WOS1`TENANT NAME(If Commercial): V t.tt`UQ it' VX(2._, <br /> OWNER MAILING ADDRESS: sTREEr po is QX L/b r ' '1 g� <br /> CITY alaIrk/SNi ti�... STATE (k)!� ZIP 9 y,?...-700 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: CA ( 4-,;,9 fl P i'()I C,._Q 5 <br /> CONTRACTOR ADDRESS: STREET ! -7?..0� f r`4 )g <br /> CITY 5t aill Gt_«./ _( STATE LOA"' k .5:r ZIP et � ) <br /> CONTRACTOR PHONE: aG� 075-b 7 tjF � CONTRACTOR EMAIL: 0"Q,rf� ;1-1,516n SI2fl)1fQ 5 i CO kik <br /> CONTRACTOR LIC.#(REQUIRED): ()44.jS '7$ri to CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER /J 'CONTRACTOR 0 OTHER(Please Specify) I0{tinr+ "rte 14 <br /> CONTACT NAME: CONTACT PHONE: ,A5--3 — c9 09 65—(--T <br /> -1-retce- 1 \t t9 1 .R I CONTACT EMAIL: T:Das h ►n(a , h'l a.1 I a Co wl <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 /> PERMIT# <br /> w ._. 7-iii-/6 PE � <br /> � , � �� l DS 63 <br /> Owner/Authorized A ent Signature Date (Revised 10/12/2015) <br />