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iiiili . .... <br /> ,s440 ELECTRICAL PERMITAPPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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: 3 0 Yock 4----e-- <br /> BUILDING <br /> ---{/ <br /> BUILDING AREA(if residential, new constructio , remod r addition) 4 2"2 SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: MMERCIAL <br /> USE OF BUILDING: /1.77~44' ' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YESA <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Min -- ha-c.v.-7 v <br /> -7v6-CF ,6-1,.% R- n 4 s---4, etei, <br /> 7' t =ce.... +'`^O fes / . r'ci,e ? <br /> . _ r .. <br /> CONTACT:INFORMATION _ . . <br /> OWNER NAME: "4"1 1^1`- S I 11-1 n• TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESJr: STREET 740 3(J 5 ` d2.4.2..„4 ✓ ' <br /> cm, vt— STATE ZIP 9 <br /> OWNER PHONE_.„ ....._. ... _... .�.. ....,. OWNER EMAIL .. * Ae '"tic-/�Cj keN—...,.-......, <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: NER 0 CONTRACTOR 0 OTHER(Please Specify) _. ..��,,.— r_r. <br /> CONTACT uetti)It` .1-;‘,..1_(\ <br /> �9k_ <br /> CONTACT PHONE: '' <br /> CONTACT EMAIL: kine,S4 1-0 lw-vtc i.,>�•••---. <br /> AGREEMENT:T 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 <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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Afigieirk <br /> r te l 3 E Go ( co ( 0 00 <br /> O •- •uthoriz-.Agent Signature Date (Revised 10/12/2015) <br />