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ELECTRICAL PERMIT APPLICATION <br /> NSI CITY OF EVERETT PERMIT SERVICES <br /> �f► 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: v.? L1 £L,/-wet. . U7/ •tV .,,?X: Vl N 16 2 3 <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: ?COMMERCIAL <br /> USE OF BUILDING: j t✓`/c '--0-i /0\f"--/t 5c. k,.... . <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ Zivv. (.....)--0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES gi NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: k k. S k a c l\v-1 t...I-t,e.... 1\k" (. 'L <-4-'" <br /> CONTACT;INFORMATION .. <br /> OWNER NAME: TENANT NAME(If Commercial): 1 S.k- &Ge-eSS Y2(el•-it14 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: NO r(<0 a 1.) djj t.A- 5k11/1-) <br /> CONTRACTOR ADDRESS: STREET 2' \0 a )t -))f- is <br /> 'f- <br /> (CITY � v v ' • STATE ZIP �r <br /> CONTRACTOR PHONE: 07-51 7 50 "t) 6 Z-1 CONTRACTOR EMAIL: Pj J eV C O(e A O(_ Co tin <br /> CONTRACTOR LIC.#(REQUIRED): t{ t,) (11)S 03 S c'-- #( <br /> REQ OF EVERETT BUSINESS LIC #REQ A IRED 3 S 3 ' <br /> y ,,,-.—.,....s.�... v_,..>a,,, . .. ,_ <br /> PRIMARY CONTACT: 0 OWNER ('CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> YV\k( --C-- Cik,,e-- CONTACT EMAIL: e,.....,4.-CU a 01 . CO 11-‘- <br /> , <br /> AGREEMENT: <br /> 1...'AGREEMENT.:T hereby certify that 1 have read and examined this application and know the same to be true and correct All provisions of laws 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 1 <br /> comply with the State Contractors Law 18.27 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE sc- , s ,ns <br /> . , <br /> PERMIT# <br /> 3/-7I 16 E ('' ,C)33 - 73 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />