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• <br /> ACTRICAL PERMIT APPLPATION <br /> I�►�j�,�- 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION iffff f , . . <br /> PROJECT ADDRESS:11.19 ?)s V(i LU,o-i-f <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: Sr-COMMERCIAL <br /> USE OF BUILDING: Cr/�Ml�Eto <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 500 6 00 <br /> NUMBER OF DEVICES(if low voltage): I <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: -ett ey.tS N.I) pc)L' Si In *0 t/L <br /> LEO c,4 5 pn(_e_c5 <br /> } CONTACT INFORMATION': <br /> OWNER NAME: S .4(\l 5&\)\Lid e.,1 Ia-t t`'}TENANT NAME(If Commercial): (i teA revx <br /> OWNER MAILING ADDRESS: STREET (0 2.1 o /,i 9 )- <br /> CITY t tj(. j h r - STATE NAN- ZIP q U a 5$ <br /> OWNER PHONE: (OWNER EMAIL: <br /> CONTRACTOR NAME: i-e( (J1mp a.nk1 <br /> CONTRACTOR ADDRESS: STREET 71.113 i tiVAI <br /> t ' ( 5 w J <br /> CITY �/'®W.* e-` ' `p n �, STATE /�C ZIP gn_73 <br /> CONTRACTOR PHONE: 3 ito'LACK -V 5 D..S-- CONTRACTOR EMAIL: S e C!i (NA `a S\€. CO" <br /> CONTRACTOR LIC.#(REQUIRED): �Q-,�(5537_E.$ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER E9 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f CONTACT PHONE:e ��t ILL 4 CONTACT EMAIL: (( �/^^ <br /> AGREEMENT'I hereby certify that t have read and examined this application and know the same to be true and correct. Al provisions of hws 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 /> PERMIT# <br /> �� 1. E S5O(r �� <br /> Agent Signa ureDate I (Revised 9/23/2016 <br /> Owner/Authorizedg t g ) <br />