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4rerr 'ELECTRICAL PERMIT APIFLICATION <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: 2st 2..0 Cu,1 C"o of <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 7 5 g SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: .VYCOMMERCIAL <br /> USE OF BUILDING: OQc,C- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES(if low voltage): /2... <br /> FIRE ALARM? 0 YES )140 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: QWY�tV" # l t( 3 2. (per- 6 a �, � e 4,14(..e. <br /> i w S t o ani cN4S i . ')fet.G...s t 'l d�T E i )0-1'Z-11+ P,t?Levu- .l <br /> Fr©lec.+ tc ad <br /> Shel dtIvx SGA CONTACT INFORMATION <br /> OWNER NAME: sI AA k1MkCZ11 C c [.P'J b� f (TENANT NAME(If Commercial):SKi jk C d, p 6 <br /> _ <br /> OWNER MAILING ADDRESS: STREET 13 2(a 41 do,etc-6%. <br /> CITY F/41,44'j- STATE to,j <br /> ZIP Cif Z d, <br /> OWNER PHONE: 147 S" • 7& 95 3O OWNER EMAIL: S akhSov, e Sv14 lJCJ . C o✓Y'1„ <br /> CONTRACTOR NAME: v Lt Y1 V~ <br /> CONTRACTOR ADDRESS: STREET 23 U Cc.4,(:f c v`rI 4h. <br /> i'"' T <br /> CITY y.�A✓O. 4+ tft STATE W`t ^ ZIP RO <br /> ZI <br /> CONTRACTOR PHONE: i7 S 7 ir3- �S 36 CONTRACTOR EMAIL: S b - d h f1,Sd t,‘ C,Svt4 QV 3. (' c,„„, <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ?(OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: // CONTACT PHONE: ,I.{2s_ _ 2 s-3 O { <br /> l.)�Q Cj�VIAS CONTACT EMAIL: S N.(""d lin SO /� t4C1p I CJ,t CV <br /> AGREEMENT.-T here.+] certify that I have read and examined this application and know the same to be true and conect. 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 /> E <br /> 0 er ut4.rized Agent Signature Date (Revised 10/12/2015) <br />