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0477 EtECTRICAL 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 ( www.everettwa.gov/permits <br /> PROJECT SITE-INFORMATION <br /> PROJECT ADDRESS: -ICI I $ C'V6g._t7,9„6.-.71:31•.) W <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: VI COMMERCIAL <br /> USE OF BUILDING: Service station/convenience store <br /> ELECTRICAL APPLICATION INFORMATION '. <br /> CONTRACT PRICE OF WORK:$ 1/6. 0d .C'a <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES ® NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Mfla 1/ 3 h/,Gi2''C®l der.,®4d S ,Ppr <br /> 4ir rrcr4 n - 17-0 v 20 <br /> CD-P0“_ 1/114€11,10, - 170 u Z0 4 A,r1 <br /> { G <br /> ,�i rA-c-e__ - 1 Zi Z. <br /> 4 v v ®rSS Co v Z <br /> CONTACT INFORMATION <br /> OWNER NAME: pAgDg&e. 114/417- ILC TENANT NAME(If Commercial): ('r , 5, cm /itt(/t f / <br /> OWNER MAILING ADDRESS: STREET .74(5 &V 9 P-(mot cvet y y � Na f <br /> CITY /r- (".6�tjf STATE A ZIP 2O 3 <br /> OWNER PHONE: FJ OWNER EMAIL: <br /> CONTRACTOR NAME: 4, Gam-/iisr/9iG. 7:-.7-Y c eTR (CAL L EC: <br /> CONTRACTOR ADDRESS: STREET /193 <br /> /f1 9 3 y A/6' ?At f,l /�. <br /> CITY hi/?Q's?.1 / STATE Cvi' ZIP ( jf V,5-Z <br /> CONTRACTOR PHONE: ZO6 3Z43 - (Y 9 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):f)U,er// L. ,5'75 4 F CITY OF EVERETT BUSINESS LIG.#(REQUIRED):O S—Z-'1 Yet <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZC 95 _ if Y5-9 <br /> I9/11I9/11- !47/1- DavrsB in CONTACT EMAIL: ??-+'rte-el Q.ytpy Ste- - i` ,( .COvti <br /> AGREEMENT:I 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 type <br /> 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/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 /> PERMIT# <br /> O /Authorized Agent Signature Da (Revised 9/23/2016) <br />