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ELECTRICAL PERMIT APPLICATION <br /> I+►� 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@everettwagov I www.everettwa.gov/permits <br /> RRO�ECT SIT NFQRMA'1'ION <br /> PROJECT ADDRESS: S(,7G1 k Com✓1 (v 1 °> {4t✓ G <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: Q COMMERCIAL <br /> USE OF BUILDING: <br /> 'El ECTRtcAL APPLICATION IINFORMATION, <br /> CONTRACT PRICE OF WORK: $ q©o <br /> NUMBER OF DEVICES(if low voltage): ct <br /> FIRE ALARM? 0 YES ( !f:NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Ane./ CQ NU.) 100 u0 (-Le� 5tri y PUr <br /> C INFO RMATION <br /> t�NTAGT <br /> OWNER NAME: TENANT NAME(If Commercial): er 1M/. .7-4C.- <br /> OWNERMAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 3 gp,912 t, J! /V L) 9C61:969 <br /> ] <br /> 9-6"; CITY 7� 'U ('/ STATE ZIP 6d U 1 <br /> CONTRACTOR PHONE: SL((c-6 CONTRACTOR EMAIL:`-j K e.ry s e-ke -f Cork—\ <br /> CONTRACTOR LIC.#(REQUIRED): 6,01-6-6-5 8-7 f C.6-1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):I <br /> PRIMARY CONTACT: ❑OWNER ArGONTRACTOR 0 OTHER(Please Specify) --V61/1126 <br /> CONTACT NAME:`(pp (�C. � rJ CONTACT PHONE: �S•70- /s�C�'/g_ 0 17 ( i <br /> O re.. 3 �'-U2� CONTACT EMAIL: •T fc..e l� K�•e y'--tom e(P�.F r ,c' An <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 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 /> Ek. -bq <br /> •wner/Authorized Agen Date (Revised 9/23/2016) <br />