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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> sOrErr <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 E (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION 9-` I LkQ .0 5 <br /> PROJECT ADDRESS: 3003 WEST CAS 0.10 RDAb, EVEi . 1--, WA '162o4 *ibu COL.-i0-S.j a/L, <br /> BUILDING AREA(if residential,new construction,remodel,or addition) KVA SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: LiatSAMERCIAL <br /> USE OF BUILDING: i shave,-t-K,.►AL <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 12.E 553 <br /> NUMBER OF DEVICES(If low voltage): N/A <br /> FIRE ALARM? 0 YES 1j2 10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): i..!/A <br /> DESCRIPTION OF WORK: 7A-mfoix.,4Rj/t!oNs-r-r-JGTfoN Pokie7278 N 1�7CcW#-Curr MODIFIc477oAty <br /> LJ i#71)IG/64E.- -olJE)GLACE/WM.1 TA.EFuia81S44#4e uT; <br /> DEVfGEME-r-ar- L7AJE) REPLACEMEIST$ 1A157741.L GPCI $128-A-K S <br /> CC6... 32548 <br /> CONTACT INFORMATION <br /> OWNER NAME: 3cEING TENANT NAME(If Commercial): 150M1,4,1 <br /> OWNER MAILING ADDRESS: STREET PD BOX. 3101 <br /> cm .SE.M-rts STATE W:64. ZIP ' 6Lz4—22-0 <br /> OWNER PHONE: 312....544. 7,-at o OWNEREMAIL: IVA <br /> CONTRACTOR NAME: .SEtwoyA1-4 E L.I:.CTIZ-1 G L.-.- <br /> CONTRACTOR ADDRESS: STREET 15135 14`E R2.14b SIT-EFS-r- <br /> are <br /> ` - T a <br /> Cn'' ReNvIot.@ WA STATEZIP Ct8Q52. <br /> CONTRACTOR PHONE:425. 4. b000 CONTRACTOR EMAIL: .kaelaY k.C?,satuoyat.Com <br /> CONTRACTOR LIC.#(REQUIRED):SEQUDEL TF 1.S'1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 40645 <br /> PRIMARY CONTACT: ❑OWNER jZONTRACTOR 0 OTHER(Please Specify) _ <br /> CONTACT.NAME: CONTACT PHONE: 425, 105. 111" <br /> GAPS/ 1- t , P12-D3Eti. MM 5•ONTACT EMAIL: ,.Sans.106%4artger @ setiojel.L.cam <br /> AGREEMENT•l hereby certify that I have mad and examined this appficalion 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 ornot 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 lam authorized by the owner of this property to perform the work for which application is made and t <br /> compty with the State Contractors Law 18.27 RCW and 296.200.WAC. <br /> City of Everett Official Use Only <br /> PERMIT# C <br /> fi.0.ia1' C IOATrn� 10.12.48 E O l.0 - J g <br /> Dem uthorized Agent Sign rerDate (Revised 9/23/2016) <br /> A kliel ot.tlaolkviga Se t:O .c,om <br />