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,IPzsz-_ __. OP <br /> !' ECTRICAL PERMIT AP (CATION <br /> I0►‘4111W,_ 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 1 FORMATION F <br /> PROJECT ADDRESS: 9 © Or-c3 W\D Ci <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: COMMERCIAL <br /> USE OF BUILDING: Vit.A... <br /> ELECTRICAL APPLICATION INFORMATION" <br /> CONTRACT PRICE OF WORK: $ 1100 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES tiNIO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ��f� <br /> DESCRIPTION OF K: C-(0 cz v� 7©(t,Q_ t`( //Iq)(q #tc/ r.� <br /> ili ite ` 0 t . <br /> i <br /> ` CONTACTINFORMATION <br /> OWNER NAME: A ,¢,„, TENANT NAME(If Commercial): AV.",. ' fA_ <br /> OWNER MAILING ADDRESS: STREET CI 0l L.64-`�fr• C <br /> CITY <2.4 t<-12 STATE (,,S LA-- ZIP <br /> OWNER PHONE: y/lOWNEREMAIL: <br /> CONTRACTOR NAME: i. 1-< ( `e� <br /> CONTRACTOR ADDRESS: STREET O ( C. . <br /> —*S3 CI, ' f�-C.c.21.-1/44� STATE �C ZIP w// <br /> Ze__CONTRACTOR PHONE: " 2. -/OS/ CONTRACTOR EMAIL: C�•k 'Q V,Q I.(/ ,e,f (. Col <br /> CONTRACTOR LIC.#(REQUIRED): L',".L 4 CCITY OF EVE ETT BUSINESS LIC.#(REQUIRELh): <br /> PRIMARY CONTACT: 0 OWNER - ONTRACTOR 0 OTHER(Please Specify)_ <br /> CONTAT NAME: CONTACT PHONE: `-e_.S �k.9 --/ 0 i <br /> �� ,c r� CONTACT EMAIL: <br /> AGREEMENT.'I 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 /> Le; . <br /> EflO - fLi <br /> Owner/Authorize. •.•• - gnature Date (Revised 9/23/2016) <br />