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477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov) www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 24o t Z-e.cotcowAy A•4 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 1 O0 SF <br /> BUILDING TYPE: 0 SFR--�DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: j`e, �; 1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ '70t on <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES XNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): \ <br /> DESCRIPTION OF WORK: r.Z'sw D^ff .S 1 C 1,&►FZ. 0o LE r, �I i 'i cr Cu) CI �C,X l 1ST <br /> (o`2 /t,) us a a-761 v 4)0 01 <br /> CONTACT INFORMATION <br /> OWNER NAME: 3\A- -I-g0 CoNsirgA,x,rti(1N TENANT NAME(If Commercial):"7"l ,5 mal 1L.g.s14-bP <br /> OWNER MAILING ADDRESS: STREET 443 MINPt-IE AVE Sv ITE A <br /> CITY SN-0 14 OM STATE \AdelAr zip 9829b <br /> 2C <br /> OWNER PHONE: C. 434 7 2 29 0 OWNER EMAIL: ( ato g rntA- O s41c° • C.OYn <br /> CONTRACTOR NAME: {-I 16,M P1'Oht L C.�"�'1 C. =NACa <br /> CONTRACTOR ADDRESS: STREET 17 Z. ) s §rppi.. c` <br /> CITY Ly*,),ti„t\Ai 0 0A3 STATE\ ZIP g sj p 7 <br /> CONTRACTOR PHONE: 2o6, 4 $4s2j-} CONTRACTOR EMAIL: d4'VeIf\ k\C p'V irt1 •C. <br /> CONTRACTOR LIC.#(REQUIRED): \- j4ACICO /Je CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 043640 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C, 4r-a, 452.4 <br /> *-1)//.►v E. A hivprot4 CONTACT EMAIL: <br /> claw e•r'* ha Innc a( , G Q vim► <br /> AGREEMENT:l hereby certify that I have read and examined this application and know the same to be true and correct. 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> qtr- 2/2-1/I5 E SO /(6, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />