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Mar 20 17 06:46a Vickie /t L1k6914838 p.1 <br /> ELECTRICAL PERMIT APPLICATCON <br /> 146.77. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 J (E)everetteps@everettwa.gov [ www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: n (4 f S A <br /> BUILDING AREA(if residential,new construction,remodel,or addition) a 0 4150 SF g __,,,, <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 /> • <br /> CONTRACT PRICE OF WORK: $ 00 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ALA. C)t te,4..l'S 4-- L_> i1 %i 7j3S i- v <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: snxEer ?Of (4 1 A <br /> • 01W r� � - I STATE ZIP <br /> OWNER PHONE: 1-f?\ _ Sb) 1s" t5 OWNER EMAIL: <br /> CONTRACTOR NAME: ��.�} .J�C�(L.C_.�C ,/��� j1`j C— <br /> CONTRACTOR ADDRESS: STREET(/�.� , D 0.4. r 1 <br /> CITY (4 l'A i'Ll i 1 t-^,.�, W'STATE Pt Zp'cz..S G <br /> CONTRACTOR PHONE: 0-691- Z.igs% 'CONTRACTOR EMAIL: ') Lg..)1 e c NA - (j;J a <br /> CONTRACTOR LIC.#(REQUIRED): ;'(�L,� �I ({� (CITY OF EVERETT BUSINESS LIC.#(REQ - D):® <br /> PRIMARY CONTACT: 0 OWNER 9CONTRACTOR 0 OTHER(Please Specify)_^ V <br /> CONTACT NAME: CONTACT PHOT ;22.-3 30 - ��(0;3 i <br /> f� .VY1 <br /> 1 1,1>z� 2 �C�{1 CONTACT EMAIL: . Dz�1�•c.."tJ�7,. 7'1 fLt.,{t,o' '1... d e. s?3w <br /> 41.01 •C <br /> AGREEMENT::T hereby certif,r that t have read id examined this application and know the same to be true and correct. AN provisions of laws and ordinances governing this <br /> type of work wilt 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 orthe performance of construction. That 1 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 RCWand 296.200 WAC. <br /> • <br /> City of Everett Official Use Only <br /> FEE <br /> ic) <br /> 'PERMIT# <br /> j/7 i .� nA4c---1 E k 3 - \L-V4 <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />