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-- LECTRICAL PERMIT APPLICATION <br /> LICATION <br /> %11CITY 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: <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFRDETACHED 0 SFRATTACHED 0 DUPLEX 0 MULTI FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> . :. . ......... ... <br /> CONTRACT PRICE OF WORK:$ CU <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> C") � �� <br /> l 2� c -v �-( G\ <br /> 0 =t r 9 G <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial):5J9-F: <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'E"(C c4—('1 <br /> C-af41 Q (� <br /> CONTRACTOR ADDRESS: STRE �L <br /> O �S`� (`R�- �ci ' <br /> CITY `C)et Orr.-`=W- te l STATE (rZIP SP-L367 <br /> CONTRACTOR PHONE: Cyo 3`k Z CONTRACTOR EMAIL: �� tiS] c�"r►� fG (sem dt;\^ )v <br /> CONTRACTOR LIC.#(REQUIRED): Ii'LE Og6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):5' <br /> PRIMARY CONTACT: ❑OWNER IfLCONTRACTOR 0 OTHER(Please Specify) 410SOL 1C.1 95-5 <br /> CONTACT NAME: CONTACT PHONE: 3 ^�f&-) 302__ <br /> 3)1)-u - t r CONTACT EMAIL: t��.� ztiC. C_„)5(2.--(; ) er'^ ,('C6' <br /> AGREEMENT:T hereby certify that!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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> L4 GIP ?). <br /> PERMIT# <br /> Own thorized Agent Signature Date (Revised 90/92/2095) <br />