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04LT titECTRICAL PERMIT AP—ACATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 (E) everetteps@everettwa.govi www.everettwa.gov/permits <br /> PROJEOT.SITE INFORMATION.. <br /> PROJECT ADDRESS: eD4 Ci3OIA Pc2t.../E, <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 UMTS: 'COMMERCIAL <br /> USE OF BUILDING: NA, N.) Q <br /> I - <br /> ELECTRICAL APPLICATIONINFokmatioN <br /> CONTRACT PRICE OF WORK:$ ( 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 1: NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: k\AN E JR ?c kpsyLmY\c,L; <br /> INFORMATION .CONTACT INFORM <br /> • s . N <br /> OWNER NAME: C - OVAA(604 hA <br /> 5 TENANT NAME(If Commercial): F-k.)V I <br /> OWNER MAILING ADDRESS: STREET \ O 170 0 <br /> e CRY STATElite ZIP CP <br /> 1 <br /> OWNER PHONE: 66- F-74 17— (..0z0 OWNER EMAIL: IY1C...YrOk.IA VS 4j'NC- r <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET \ < 2O C t4- kie k <br /> crr( Setxnt.e STATE A.)P‘ ZIP cN) <br /> CONTRACTOR PHONE: 90 6._ 747-64-i S CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): iZZ41. C.,F CITY OF EVERETT BUSINESS LIC.#(REQUIRED): +(ea-) - <br /> PRIMARY CONTACT: DOWNER CONTRACTOR 14 OTHER(Please Specify) /' <br /> CONTACT NAME: CONTACT PHONE: 2)(c) 2 2ti- q19) <br /> N\t-Mtiov'S CONTACT EMAIL: kry‘a, riuS ff4" tv • 00-NC t PrA, <br /> AGREEMENT:Thereby certify that I have read and examined this application and know the same be true and correct. All provisions of laws and ordinances g6Arning this 0- <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 /> PERMIT# <br /> jIM <br /> 21\j\ 117EOOC <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />