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00011111111t_ ELECTRICAL PERMIT APPLICATION <br /> `411 -7-1CITY 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: /U 7/0 v "73 g_45:76771 tJ 4 y <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: RC X009 � j 001) 'AA.( f�111-GUI4 <br /> CONTACT • <br /> LINFORMATION ',— <br /> OWNER ✓-�5661- /r emit i5 o9�7 TENANT NAME(If Commercial): L�l�(�'�ii.� 110111'145 <br /> OWNER NAME: C�r � .. <br /> OWNER MAILING ADDRESS: STREET (A(L 'l i .54 5 r 6 CO <br /> CITY .5.679- STATE ,/]r 7 / ZIP ?g/°2.-. <br /> OWNER PHONE: �a-s'3S,S-x-58 OWNER EMAIL: ckDI1,n3® ASSEf Cfrc , Lamm <br /> CONTRACTOR NAME: 5 pi L /� <br /> CONTRACTOR ADDRESS: STREET C7 p�� Po jai f1�L ?/14GL S0 JA /1 <br /> CITY 56/9-44-1C / STATE IL)/ <br /> �1 ZIP ggj <br /> CONTRACTOR PHONE: c2OCe -3a-9•-2_0110 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): �~ 1 N et/)1� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �J39205 <br /> PRIMARY CONTACT: 0 OWNER to CONTRACTOR I OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: g-B(� -!/7/ -‘ ,..c1 77 <br /> 'Da k in.6c4-11-4-1v•• CONTACT EMAIL: <br /> AGREEMENT:I hereby e fy 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 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 /> PERMIT# <br /> 7:7-? E 7 3 <br /> O r/Author gent Signature Date (Revised 9/23/2016) <br /> 944-e (J' <br />