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tLECTRICAL PERMIT AFPLICATION <br /> 101114gy 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 www.everettwa.gov/permits <br /> PROJECT SITE INF®RBVaTIOk <br /> PROJECT ADDRESS: '72 0-7 Ev y r g-{7 (A.)4y S w 1 1-e C <br /> BUILDING AREA(if residential,new construction,remodel, or addition) /0 0 0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: MCOMMERCIAL <br /> USE OF BUILDING: Te h q — O ed)O me,- <br /> ELECTRICAL <br /> erELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2 ?D O . ° ° <br /> NUMBER OF DEVICES(if low voltage): <br /> FiRE ALARM? 0 YES IRI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,/ <br /> DESCRIPTION OF WORK: (�/i v t? C(i Ito T t elf rt f- h �� (�(�at,��i1 G✓ "� Dryer <br /> 3 C C t 'l✓!� ?l'-1• r '- 11 Go47's 3 4-g C..✓ pws /V) <br /> l�Sc1l� eS , <br /> CONTACT INFORMATION . <br /> OWNER NAME: ' f "p'0 vit.,— TENANT NAME(If Commercial): I'1 tkd y Q©) NA <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: Zc'b-33 S,- O S '3 OWNER EMAIL: <br /> CONTRACTOR NAME: —€74%-c—r1 <br /> CONTRACTOR ADDRESS: STREET ?b 122.1r <br /> CITY 1.-4144-t �l�"e✓�S STATE L)A- ZIP 5 gZ s ng,1 <br /> CONTRACTOR PHONE: 20(0 "ca.53"toy Z q1 CONTRACTOR EMAIL: E!i C L�44,1 p <br /> CONTRACTOR LiC.#(REQUIRED): -C-\"1—tA ?An CITY OF EVERETT BUSINESS LIC.#(REQUIRED):SS 1 1 Gi <br /> PRIMARY CONTACT: tK OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ` O,, CONTACT PHONE: ZOO -- c, 3— (092-i <br /> II c- \ CONTACT EMAIL: 'r`Cic.,01.10 <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 lam authorized by the owner of this property to perform the work for which application is made and! <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 /> 23 �� 1 � l - Oz1 <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />