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02/24/2017 09:15 FAX 11002 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,400104 .7 I. <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)evsretteps@everettwa.gov I www.everettwa.gov/permits <br /> --PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: a1�03 4247/71'0 * I Y lir F r A of--- ...L�d <br /> BUILDING AREA(if residential,new construction,remodel,or addltion) 2 SF <br /> BUILDING TYPE: 0 SFR-DETACHED OSFR-ATTACHED/ 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> ,USE OF BUILDING: lack ide ) C ( iill e <br /> �.._ ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(If low voltage): <br /> FIRE ALARM? 0 YES -7 NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable): a 14. ),;,... -ie.,1 <br /> DESCRIPTION OF WORK: C' .A ,61,- I 14:7-).( 6t71.ei• /'` -r-I-, <br /> ', j d t • i '/ i-S - . r 1-1,0 mit) e ..,, 4. <br /> 4 —' <br /> - r' '' J - r O e f r t 7• .... <br /> • a• �: I' b `Ai- - /' • . ',. ,4-, � pJ s- �..,:; vAC <br /> --•'_f* <br /> � -.sr <br /> yd 8- - - Ad, .1.. <br /> CONTACT INFORMATION <br /> OWNER NAME: �J! .Q.01 j) /�y ,, TENANT NAME If Commercial: <br /> OWNER MAILING ADDRESS: s artI' , C2l, ice'/ 1Y <br /> Gm I�f,. sTATrs W//,4 a. `�l�a.?' % <br /> ` <br /> OWNER PHONE/ 3'53- g OWNER EMAIL: ,/x 7L-41.0 l ' j- >,S 14// .e-!.0 1 <br /> CONTRACTOR NAME C' ,X1 '`rt. =w JZ ? N - _ .. - ____ <br /> CONTRACTOR ADDRESS: _ STREET L9:0• tad,X (.44,' <br /> cry x_6,47 ) I le. STAYS Ae +/_,` 9P 9 37 <br /> CONTRACTOR PHONE: ,..7' •- £3/ / CONTRACTOR EMAIL: ze 4k la--f 7_1C- ar`Yl , <br /> CONTRACTOR LIC.#(REQUIf2EDyCkELEj.TaZ 419 CITY OF EVERETT BUSINESS LW.#(REQUIRE_'I Cel/ . 3,, <br /> PRIMARY CONTACT: ►: OWNER CI CONTRACTOR 0 OTHER(Please Specify) a e" e-n ' A <br /> C TACT NAME: CONTACT PHONE: (,4 jv -60 4� <br /> � )� \\::rr y J yy� -1 <br /> JMJW''irk HNt&( CONTACT EMAIL: ,f zjk ope...44 %)CJft^!t_.5�0'1;4-Gc,+�,'• 1.. <br /> AGREEMENT I hereby certify that l have read and examined this application and know the same to be_We and Cone AN proylabns Wawa.end ordinances poveming fills type <br /> of work wE be completed whether specMed herein or not. The granting of a penton doe/not presume to ghe 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 thls property to perforin the work for which application Is made end I <br /> comply with the Slate Conhactora Law 78.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Ager►—tinter* Date (Revised 9/23/2010) <br />