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Aw <br /> ILECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vigal <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 /> ; ::.PROJ_ECT:;SITE-INFORMATION: <br /> PROJECT ADDRESS: D�O \AC Pip.( 'LL <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: ' Lf5S\\-' 1(1,fi „ <br /> :..': ::, :::ELECTRICAL APPLICATION INFORM ATOON :',•::..::','.:. <br /> .: .:_' :, :.;;: . -,:.: <br /> CONTRACT PRICE OF WORK:$ Lo ce, <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): n - <br /> DESCRIPTION OF WORK: \\t cSA-P�\ ( D P4 eC '1( 5`� C &c.Gt-l.- -- ' l--).Z- <br /> S W) 1C7( \&•cV iSr-Ioi' <br /> ..:.: : ,CONTACT INFORMATION <br /> OWNER NAME: A zJ - \S AvkAnk71 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREE9 O r1C IA L LQ 1\--11t-';' <br /> CIT <br /> �� - YICY STATE M` r 1 ZIPg5?VI) <br /> OWNER PHONE. 1/4{D�"" ,O,-S.O OWNER EMAIL: CA l 1 <br /> CONTRACTOR NAME: ` (r C' op'\tZ4 -cL e ,f c <br /> CONTRACTOR ADDRESS: STREET <br /> \5 3 '\ F; <br /> I V S <br /> CRY Ii�_`•W STATEWM- ZIPCI 0,)":0 5 <br /> CONTRACTOR PHONE:4---\?.5-^1J5r1:30Ak.153 CONTRACTOR EMAIL: 4V\ @, ArTS,AA01. <br /> CONTRACTOR LIC.#(REQUIRED):/1'L�k kO l tJ..V-L 2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): I 4 <br /> ... <br /> PRIMARY CONTACT: ❑OWNER )PONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /// CONTACT PHONE: j 31— �j`D 0 J �� C � ,t.(S CONTACT EMAIL: A ),f-N@f En -C-0 <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 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 /> 4 lt2 <br /> PERMIT# <br /> C-- 6N/\/ <br />