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,IIIP',"..,/—,A ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@ia evereftwa,gov( www.everettwagovlpertits <br /> PER JECT SITE.:INFORMATION <br /> N <br /> PROJECT ADDRESS: � <br /> 1 \-1 t�.cv�;-c, c,�c� �3 O©,r-A-90coo 3244 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHES) '0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> " <br /> USE OF BUILDING: <br /> I IL CTRICAL APPLICATION 1NFOR ATION <br /> CONTRACT PRICE OF WORK: `kd <br /> NUMBER OF DEVICES(if low v tape): <br /> FIRE ALARM? ❑YES PO E) <br /> ASSOCIATED BUILDING PERMIT pplicable): <br /> DESCRIPTION OF WORK: (inki Ys N'-AN, , t 1t t l;tv rf f.e. c.,14. I C,f.k o(ca: <br /> , VT r, ..�. Ai AC,1114, 5 r(Aa /‘1\P4tek.. );Qr42 Ctriks,Nrr <br /> CONTACT INFORMATION <br /> OWNER NAME: ( , ,r~ tAl c,..IA TENANTp E(If Commercial): <br /> OWNER MAILING'ADDRESS: STREET t 1‘e)\ $( ';3r H c el el <br /> CrrY `-3'V.L tri..-0 STATE . . _ ZIP gig- O0( <br /> OWNER PHONE: LI,-),s--.--7c o4 ,t )- OWNER EMAIL: li <br /> CONTRACTOR NAME: Gt, ti.Ac trd '6 le.c-t :t✓i T--�r•C P <br /> CONTRACTOR ADDRESS:. s iEm *".\)1Z)rbcSK q <br /> crrr Y1 4, o(4 STATE t)„3-4\ zip • '`. ,. <br /> CONTRACTOR PHONE:'t -11 a- t Ci t CONTRACTOR EMAIL: (; 't j to r C,5(Act k • ' >'- <br /> CONTRACTOR LIC.#(REQUIRED:VTCL14-SE. I 3 ai?..4,,k, CITY OF EVERETT BUSINESS LIC.#(REQUIRED): tsi.q't{Lf.1 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)' <br /> Now <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT l hereby cerhly that l have read and examined this application and know the same to be true and correct Alf 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 l am authorized by the owner of this property to perform the work for which application is made and <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> lik <br /> . . 111Elqog -- 125 <br /> Ow ed ent Si ature Date <br /> g (Revised 9,23/2016) <br />