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L�/ ECT ICAL PERMIT A LlCATlON <br /> ,;;;,01 <br /> ; CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E) everetteps@everettwagov J www.everettwa.gov/permits <br /> P Fa@AMOT SITE 0NF•`R ATII& <br /> PROJECT ADDRESS: Ob. (,yS1/4 COSky10 2cod L'tb -407, <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: (xi <br /> ELECTRICAL APPILICA' ION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 1400 <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • DESCRIPTION OF WORK: yetoCdl,A-ef <br /> :.; :.._CONTACT:INFORMATION. ::_ <br /> OWNER NAME:' \e_ CO(?\[ . 4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rn (ZZ` .ZV i(t / <br /> errs 1-0A/k- STATE Lt) ZIP q 603 2 <br /> OWNER PHONE: 2-5��1�j '3t =j(L{ '7 OWNER EMAIL:4 <br /> 1 <br /> CONTRACTOR NAME: 1.e1�VY� � � <br /> �� 1 coyy va. ,1M <br /> CONTRACTOR ADDRESS: STREET v-42(. ZhY- 'V �,�/ <br /> CITY - STATE l..()r ZIII Q 32 <br /> CONTRACTOR PHONE: 'L�j� �jC�— /1(4 7 CONTRACTOR EMAIL: r(,{,)1.0,rLQ. <br /> CONTRACTOR LIC.#(REQUIRED) .... .. .h <br /> y3S CITY OF EVERETT BUSINESS LIC,#(REQUIRED):b3-7 `�dZ <br /> .........:..... ......:_:,,�D):,..:,. . .... . _. -�:,,,....:,:.w..R.�..,.,... <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 9..4, <br /> KKt..eis50CONTACT EMAIL: ki.k.A Cerye <br /> 6,Kov ar4x1,, <br /> AGREEM NT.•T hereby certify that I have read and examined this application and know the same to be t e 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!am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296_200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> f 0,a0 <br /> PERMIT# <br /> 16[1 it F igi <br /> Owner/•uthorized Agen -ign. u • Date (Revised 10/12/2015) g 3 <br />