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ELECTRICAL PERMIT APPLICATION <br /> O 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: 9 0 j W Fsr c DE1Zg--nr g z o ef <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: M Rco &gs ,S7-47-/o/t/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 3 s-00 . 0 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 4 n <br /> DESCRIPTION OF WORK: �e,(-1oc/E" 4--A1A f EPe /�C� &'15o -/Ali .UCSF ELLS <br /> (4o ur/kE is 8ci, '& Pa /AI ) <br /> CONTACT INFORMATION <br /> OWNER NAME: I/or ,r IR ,r ar:•01 t.,i rTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 12-( - M 2 <br /> CONTRACTOR ADDRESS: STREET 3S-Oc? 0�E 1214, Cr- <br /> CITY <br /> -- <br /> CITY L Ata itesT P STATE LUA ZIP"q T I s-s-- <br /> CONTRACTOR PHONE: 426• 77 3 - /$a-d CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED) -n-Z_t M L *- cn 1 PS CITY OF EVERETT BUSINESS LIC.*(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4-a5 - <br /> t( .��o/1-/J- CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that l 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 /> • ( <br /> � <br /> l SO <br /> PERMIT* <br /> E 7Oc l7q <br /> S • 3o- 0)-6 /'7 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />