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ECTRICAL PERMIT A.ICATION <br /> I�►��r,�_ 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 /> t fW . j Jttaf - ROJECT SITE INFORMATION i<a . .. ..,; . .,l _ . ... ,_.. :.. ..< : O3,_., .. .= <br /> PROJECT ADDRESS: 503 `c3 -- Si. J .-v"c ; rt-, <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF ��q <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 1.-eOMMERCIAL <br /> USE OF BUILDING: C <br /> =ELECTRICAL APPLICATION INFORMATION' <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): • <br /> FIRE ALARM? 0 YES &1O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): f <br /> DESCRIPTION OF WORK: Ad tqte90 ,& / S'''t tilCe_, <br /> CONTACT INFORMATION <br /> _s �� _,. a -.., ,.. <br /> OWNER NAME:TQ(4 O r Ejefeytk- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Snloky Ali.,-79/ £-/e 4,G <br /> CONTRACTOR ADDRESS: STREET S.-)Q 42dill-it 6-/U� 3 . <br /> CITY 1/Yl. n / STATE �J� ZIP �( 3 <br /> 7� <br /> CONTRACTOR PHONE: S 7SO - (at, CONTRACTOR EMAIL: riot tilit51tiao ,hle[e/C.,co X"..... <br /> CONTRACTOR LIC.#(REQUIRED)S440 Pe..933$1• , CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT AME: CONTACT PHONE: �5 750 -3,/&,... <br /> ��rr CONTACT EMAIL: / J <br /> /i CL ,,i' I1 � 65YKbl/ft/0ietZ-44-iC it'IArrt. <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions�6ffaws 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 I 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 /> P(iO3--ti(a(10 D®lo <br /> / PERMIT# <br /> ," - f-v Alb <br /> 6%3 / 6, E 1 o(0-- 12. <br /> •wner/Authorized Agent Sig,:ture Date (Revised 10/12/2015) <br />