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ELECTRICAL. PERMIT APPLICATION( <br /> Ii► CITY OF EVERETT PERMIT SERVICES <br /> `' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMA,TION`. <br /> PROJECT ADDRESS: 4110 3 Rt '46rt ONr P,>'• <br /> • <br /> BUILDING AREA(if residential,new construction,remodel,or addition) /y 7.6 SF <br /> BUILDING TYPE: VISFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: SW <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ q apo, C° <br /> NUMBER OF DEVICES(if low voltage): f <br /> FIRE ALARM? 0 YES KNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /06010/4-42,6(4)//146 <br /> • <br /> CONTACT INFORMATION. <br /> OWNER NAME:MA 4 -so./ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: /;,`OW�NyER EMAIL: <br /> CONTRACTOR NAME: PM4 I_, ,7?t4Z--,.CO,,024C(041 reV4 _. .... .. <br /> CONTRACTOR ADDRESS: STREET /41DZI srD Ave me <br /> /� �j c <br /> Y' e <br /> CnY (-rO (//N� STATE 44 ZIP ` r.5 <br /> CONTRACTOR PHONE:206,749. " CONTRACTOR EMAIL:77'►'h 77141 61+e .i' <br /> 6,41 <br /> CONTRACTOR LIC.#(REQUIRED): PTI — = 742. CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O22(5 <br /> PRIMARY CONTACT: 0 OWNER • CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:, CONTACT PHONE: 2,)(o,14/?• 7Z -79q <br /> `j/ <br /> ►iLt2/ CONTACT EMAIL: flk l6'p*167e1 7.Z4 67141 <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 properly 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 /> Sa <br /> PERMIT# a, <br /> ��23/zolY <br /> E \ 9-0S - <br /> Own=/Authorized ;.entSignature Date (Revised 10/12/2015) <br />