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4ln' ELECTRICAL PERMIT AF1f LICATION <br /> CITY 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: 9`"13 3 p P t_c_.: 5- O2Jt✓ t 1 <br /> -7-- <br /> BUILDING AREA(if residential, new construction, remodel,or addition) _SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 4TCOMMERCIAL <br /> USE OF BUILDING: M Ei e_ip� e NI-C._ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 3 0O e'� • <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES %NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` <br /> DESCRIPTION OF WORK: ,Zt1 i--c,(.1 l C,Qu, d10 A OIL`S `\Y\ 1,1?.,)c. `�7.Q,n.CW t A- <br /> O '�.r) 'c A�.>z. Qo r 0 or r «vuTr <br /> CONTACT INFORMATION <br /> OWNER NAME: C�(z0\...) ' irt-ent,i1,1 TENANT NAME(If Commercial): (..C11t cup Ake---Aci <br /> OWNER MAILING ADDRESS: STREET R l tit)RLL 3T 9e/. 2/ <br /> CITY �,i `-1-1.- STATE tA;A zip <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Q.,....13. <br /> RR <br /> CONTRACTOR ADDRESS: STREET \"C a(7 S P\e j 4 760 <br /> CITY S oA.CTW STATE ZIP 98{�f <br /> 01 <br /> CONTRACTOR PHONE: �O(O-7 c= '' (1c'1 A CONTRACTOR EMAIL: MC in-\a(1(/$o c i. r 1.)(k . <br /> CONTRACTOR LIC.#(REQUIRED)C" j9FC, Ai.. C.V CITY OF EVERETT BUSINESS LIC #(RNWIRED) 041,.E 7 j <br /> PRIMARY CONTACT: 0 OWNER r CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N E: \�1� CONTACT PHONE: ao Y. �4 ( i(C <br /> i \c:�_ Cj 'l.ovY\tic, CONTACT EMAIL: �Y/�(• L yy.\a.v,LA l(-�' (,y kC / 0�( <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All prow ions of Ia'v s pnd ordinances ge ruing 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 he provisions of a ther state or <br /> local law regulating construction or the performance of construction. That!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 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 0 PERMIT# <br /> I� 'f! , / Q7OC//6 E i� V)HU4 <br /> Owner/Authorized Agent Signature D (Revised 10/12/2015) <br />