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grr • ELECTRICAL 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> : . ' - - :: • : •.: ° .',.PROJECT SITE INFORMATION -,:-'::''.,-1: :!;.-.. ' <br /> PROJECT ADDRESS: 3oc>3 WEST G'ASfnJO R .DAbl, EVER.e7T WA 9820¢ 0 *, 1l f <br /> BUILDING AREA(if residential,new construction,remodel,or addition)_WA SF / <br /> BUILDING TYPE: in SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ,_,vOMMERCIAL <br /> USE OF BUILDING: 1,•44%-t-4UFAc'TiJta.I1-1C-1 <br /> . . ELECTRICAL APPL,ICATION:lNFORMATIt(?N <br /> CONTRACT PRICE OF WORK,/,!, <br /> NUMBER OF DEVICES(if low voltage): KVA <br /> FIRE ALARM? ❑YES ‘,12rNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): NIA <br /> DESCRIPTION OF WORK: TZ"MP0K.41.y Gtrnl)S eilcriO7U pe5W 8.At.LCN WRCLflrMcA{FIQjT1OAL, <br /> 1-1GarfA1C 6AfE-0140e-GrAlE)RE701-Ar-Eit T/geFU/28f.SF1Mt'alt1�' <br /> DEVICE/ AIE- -OAIE)t PL-AWME'IUT 44 INS-7-ALL GFR/ 812E, d(e <br /> e1ag43z•4310 <br /> ,•::. OI CN TION ' . <br /> .�• A:::O FOItM,A <br /> OWNER NAME: BOrtS/IVC: TENANT NAME(If Commercial): g' A1G <br /> OWNER MAILING ADDRESS: STREET pa L°iox 3707 <br /> CRY A-rT^t...Oi sum WA ZIP 98/x4-2747 <br /> OWNER PHONE:3/2. 521,2:041. 2OWNER EMAIL: MAA <br /> CONTRACTOR NAME: -QUDyA41 eyer.Tilit2. Lex._ <br /> CONTRACTORADDRESS: STREET /5/35 Ale 9,2-Alb .S7 2 T <br /> CRY ge bMt7Nb STATE WA ZIP 1,43a52. <br /> CONTRACTOR PHONE: 125. 8/4. boon CONTRACTOR EMAIL: crahy.foekTrtgerCvtse1u`ya1.&ay] <br /> CONTRACTOR LIC.#(REQUIRED): SEQUOEL 977s9CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 1D/o75 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425• q.2,545 <br /> JIM AtUbEPSON1, GENERAL-F iaEMAM CONTACT EMAIL: 3i ryi Av tet-So r C? seciluot .t• f=Snvt <br /> AGREEMENT I hereby certify that t 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 lam authorked by the owner of this property to perform the work for which application Is made and I <br /> comply with the State Contractors Law 1627RCW and 290.200 WAC. <br /> City of Everett Official Use Only <br /> FERMI1tUZ - <br /> 9GARY A B ER 13.2.2. /8•� E <br /> Owner/Authorized Agent SignatureDate (Revised 9/23/2016) <br />