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4477 ECTRICAL PERMIT APICATION <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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1o° &Gici t Rut.: EVCrc t4-� Gt}-l1 <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: / <br /> ELECTRICAL APPLICATION INFORMATION , <br /> CONTRACT PRICE OF WORK: $ Z9I04"2-- <br /> NUMBER <br /> 2 -NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(iflapplicable): n <br /> DESCRIPTION OF WORK: Ac.�dl 3 wg r c( Qa K t%;its i n CI P*6 c c a rc4 <br /> (oor o-F Gc)o e.K cas- Gii(tel/-413 eeK.kr <br /> CONTACT INFORMATION <br /> � <br /> OWNER NAME: r�'OV:cktneG k(e4QtCQ I tei.kr- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> crry STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: vc.cA t�CGFr• t. <br /> CONTRACTOR ADDRESS: STREET ?C )O)C gdLI(a A <br /> cry �Ci.44 V STATE 43 ZIP RS(0 <br /> CONTRACTOR PHONE: 204^'13(,-V200 CONTRACTOR EMAIL: �r- <br /> CONTRACTOR LIC.#(REQUIRED): VrCAECZ S42.MV CITY OF EVERETT BUSINESS LIC.#(REQUIRED): DO'4 i(4 <br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: joie- <br /> CONTACT <br /> CONTACT EMAIL: StS�'1_�c r^Otnw k e, VE C'&eoesi <br /> 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 l am authorized by the owner of this property to perform the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 44t l <br /> PERMIT# <br /> e/fj/ 12 ,� E t i2— �c�5 <br /> 0 er/Authoriz Agent Signature a (Revised 10/12/2015) <br />