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gr.'. ELECTRICAL PERMIT APPLICATION <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\,�' Qpm <br /> PROJECT ADDRESS: CCA 0 2 C a,Q(IU f-oacQ Vere , v V A 1 v�,03 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: YI SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING:�kiNeS t QLJ,f-t-iQ S - <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 91500. C O <br /> NUMBER OF DEVICES(if low voltage): N I A <br /> FIRE ALARM? U,YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): N 1 Pc <br /> DESCRIPTION OF WORK: V-NC1A).1 f xiroocos , 116 r10(t r i n(� r } 1 <br /> tL vt\ ac-Ci�i c_e, _ L aruc\oC,r e -xe,r► or , C� <br /> J <br /> � a tf, <br /> Cioccu.i�R� - 2 - 20 am P V-a- aepJianu, cir'cuft.� . <br /> CONTACT INFORMATION <br /> OWNER NAME: Lu I Cs AY 0r,`'xe. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (402, C a 1ZOCt( <br /> CITY F,V c reit STATE \NI I c ZIP q 610 <br /> OWNER PHONE: OWNER EMAIL:M� <br /> CONTRACTOR NAME: e drown (/C&[�(�1 1 i ci 1. o <br /> CONTRACTOR ADDRESS: STREET-PO J3DX 155 c<E5 <br /> CITY Seams+ J - y�(� .SpTATE W I\ ZIP L.I5 <br /> CONTRACTOR PHONE: (p' 905 3(0-'1 0,�],� CONTRACTOR EMAIL: 1 1 IQ (1Cte,eatVwne'cc r C, -Com <br /> CONTRACTOR LIC.#(REQUIRED): (SFA 1 O�,Uj(Ov (2-.6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):53 t I (O <br /> PRIMARY CONTACT: ❑OWNER ` 1 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / ` CONTACT PHONE: 7.0(.9 905 3L9 q 0 <br /> Ka 'oej CONTACT EMAIL: , a.�. a&S.ea-fOw Week-t +c .coen <br /> AGREEMENT:I Pereby certify that I have read and examined this application and know the same to be true and rrect. All provisions of laws and ordinances governing this type <br /> 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 /> 4 0 City of Everett Official Use Only <br /> ,A` PERMIT# <br /> a f)v rfiarOn crgo 1°0 E ( O 3 053 <br /> Owner/A horized Agent a ig : ure Date (Revised 9/23/2016) <br />