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/11IPP-fg <br /> 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: 30 M 1}11‹ 1 LTe 0 RI V 0 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF �f <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ItCOMMERCIAL <br /> USE OF BUILDING: <br /> ELECTR APPL ATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /©Pow <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES �NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: lZ-e Moue pe/ve ( ®fEl,livr- p IA.ci7 <br /> CONTACT INFORMATION <br /> OWNER NAME: F 6-1 ( , r/Aj Codi f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 Ei 1 1 UJ /4 G LC t f ec) L ld r <br /> e ae r-Q`f, cm, 4J /- • STATE ZIP y7?./� <br /> O <br /> OWNER PHONE: 14.2 L>'`"-_.2- ) — 0 0 / , OWNER EMAIL: 111 CY <br /> CONTRACTOR NAME: W 11' eUP*--- -t6t/tylx. S <br /> CONTRACTOR^^ ADDRESS:rSTREET I �J' i /9 -4,.. ?--1 i e/v 9 44 n. [�m <br /> L�M` A VI(k?( CITY \J J1✓ 9 STATE �r/'�(98 ZIP <br /> CONTRACTOR PHONE: ►-.-.._._ G L . TRACTOR EMAIL: 1A) IA t "l.. C✓' �, (9,-1_ 0 -.7....:-:4., <br /> CONTRACTOR LIC.# - QUIRED 61-(=ce_ U R 3 3 ' CIT' : EVERETT BUSINESS LIC.#(REQUI:'i <br /> 54080 <br /> PRIMARY CONTACT: im . NER LJ CONTRAC I UK _a U I HEK( lease Specify) <br /> CONTACT NAME: CONTACT PHONE: �..)- — Z V Q -- 30 b3 <br /> 7-cii./ _ paY)C__ CONTACT EMAIL: 7 �l <br /> AGREEMENT:I hereby certify that I haead 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 /> 0 City of Everett Official Use Only <br /> ,4# e / / / 7_ , PERMIT# <br /> E no g-002, <br /> Owner/Au".rized Agent Signature Date (Revised 9/23/2016) <br />