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047T !LECTRICAL PERMIT APPLICATION <br /> 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 300 3 Ltif A , i r10 kb 416-2S I-4 IC <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: A)COMMERCIAL <br /> USE OF BUILDING: Ph F C2 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3o 1( <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 011 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 4,431 I 1004 j (o CJ I Grey,- k r 3 a jG c e,1 L. <br /> 1 z b ISc -1 4- I? $r)v Gvd 1c4--S <br /> CONTACT INFORMATION <br /> OWNER NAME: g0 e-1vo3 <br /> Cc>i P Iry f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (j 6Oc `3 '] PkS 4, 4 / 61 <br /> CITY 3eA-1`k STATE to tA- zip /21 / 2. <br /> OWNER PHONE: j OWNER EMAIL: 1 <br /> CONTRACTOR NAME: -/2G$1'CJ(vst iP c f w C <br /> CONTRACTOR ADDRESS: STREET Lig 13 L � <br /> (_HeYUk)14,)14- 6eikj, Kb) �/� o <br /> CITY /lit V 1(1..‘ <br /> L l ( STATE r-7- zip -1 $2 7 s <br /> CONTRACTOR PHONE: 20(0-353-1408 b CONTRACTOR EMAIL:'Z"-$4-90,..%.5 G texe-rUc►�Du4c ' , 00,41 <br /> CONTRACTOR LIC.#(REQUIRED): � G{ i ' 0 5 5 K CITY OF,EVERETT BUSINESS4LIC.#(REQUIRED):Og 5 as? <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ( CONTACT PHONE: 2.0(0-35 3 I/O S , <br /> T4-S3-‘) CONTACT EMAIL:.3,-4.50"...7 5 c. � rEG.f Y7 y py4.4.3• G6.1", <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 <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 /> 4g-t) <br /> / L <br /> PERMIT# <br /> -16 S E 1 11 C� <br /> Owner/Au onzed Age S Date (Revised 10/12/2015) <br />