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047T 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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECTSITENFORMATION <br /> PROJECT ADDRESS: ) <br /> BUILDING AREA(if residential, new construction, remodel, or addition) I:000 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: Et-COMMERCIAL <br /> USE OF BUILDING: (13con_ Saij <br /> . -MLECTRICALAPPLICATIONINFORMATIOW: <br /> CONTRACT PRICE OF WORK:$ e-,cv 0:7) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0:e6r) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> p,c )v jr, Vjc Ve5SP te, <br /> kk ) <br /> aoi? HUI) ck.rf 1(ow-Ce-1 <br /> CONTACT 010.1*70010,41C.4.!!:' <br /> OWNER NAME: A fik.evqx(Oa,j br-A,E-avOi p,i ,:,5„„,_ TENANT NAME(If Commercial): +t\ ASiltud j <br /> OWNER MAILING ADDRESS: STREET 7).09 7 LtlIA-64- Ilik) FCAlt(SOIA <br /> CITY 1/10,4150011._ STATE (ADA ZIP Ci gd...~7e) <br /> OWNER PHONE: 'OWNER EMAIL: 49,,, cocit,„,ov,(4.1( cat/4,0.03k <br /> CONTRACTOR NAME: Pm, , Oro vwe Cç <br /> CONTRACTOR ADDRESS: STREET ;212, (0f1"" 4 ve. GTE ,9- t <br /> CITY Ge(2).. STATE ,....);:k ZIP <br /> CONTRACTOR PHONE: 9-0(.9 (9.9 02 CONTRACTOR EMAIL: Zck co-,A,. • <br /> CONTRACTOR LIC.#(REQUIRED): 991.1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):05104; <br /> PRIMARY CONTACT: 1:1 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (906- '71 .3(9,(9 <br /> 7tt_rE Wei Cti- CONTACT EMAIL: atzti_t),,)&111) COVIA <br /> AGREEMENT-I hereby certify that I have read and examined this application and know the same to be true and correct. All Arovisions 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 /> City of Everett Official Use Only <br /> /7 PERMIT# <br /> E 1104-- IH <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />