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iljaELECTRICAL 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 /> ::_•° ';1,PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 34,03 WEsr a fiao ADAd�i aVaeerr WA 98204 ; „4 --' 11.Z ... :` <br /> BUILDING AREA(if residential,new construction,remodel,or addition) (V.4 SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: M.•►•NUFAC-rUta..It.lC:t <br /> • :•-:- , - 0140$I6:10^401.00.0,10$::INFORMATION . • <br /> CONTRACT PRICE OF WORK % 4 <br /> NUMBER OF DEVICES(if low voltage): MIA <br /> FIRE ALARM? 0 YES 1,1?(NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): N/A <br /> DESCRIPTION OF WORK: 7EMPc1.44,€y 6Cr05.77p.tlG77o7V PoWM/ atedt LCN GRCU(r M01a{F cA-norl, <br /> DEVICE(0 We—FOS-OW)/2EP-AL'8MtrMMT 40 /AI.S7Aa GFCI <br /> elcg#32436 <br /> . ... .... ..... <br /> :���.;�':'CON7`ACT;[NFOitMAT10N ' <br /> OWNER NAME: ,Be-ewe TENANT NAME(If Commercial): EZt(a <br /> OWNER MAILING ADDRESS: STREET PO &A .3707 <br /> Crit ..StgAir'r'n.„ STATE WA ZIP 98/, -27 <br /> OWNER PHONE:..g/ .541. 2oov OWNER EMAIL: 1 4 <br /> CONTRACTOR NAME: ,SQr oyA• ez_e-4..Thia. LLC. <br /> CONTRACTOR ADDRESS: STREET /5/35 NE 92.Am 772 7 <br /> Cnw geAMOMII STATE WA ZIP ?e05.2. <br /> CONTRACTOR PHONE: 12.5. 8/4. 1,000 'CONTRACTOR EMAIL: g44r4,10e(c111.9er sectua jak).&sni <br /> CONTRACTOR LIC.#(REQUIRED): S•ere L 977.19 ;CIT•Y OF EVERETT BUSINESS LIC.#(REQUIRED): 1O 1•5 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.221.,545 ` <br /> ,Ji IN At1bE�5ot�1, G -'Fai2EMi ! CONTACT EMAIL: JjYri•AVlders°toG I�lote. IN• 0.brit <br /> AGREEMENT:I hereby caduly 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 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 i am authorized by the owner of this property to perform the worts for which application is made and i <br /> comply with the Slate Contractors Law 18.27 RCW and 288.200 WAC <br /> City of Everett Official Use Only <br /> PERMiT# <br /> GARY A8 ER .6•2 - /6 E \gos _ L11 <br /> Owner/Authorized Agent Signature Date (Revised 9.23,2016) <br />