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ELECTRICAL PERMIT APPLICATION <br /> 4:errs <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 I www.everettwa.gov/permits <br /> :s*r�:, v� a '' � .: o x#'e3�� M ,t t, e €,: 'a *.s w,s b'� c v "�a r <br /> six M1 �_� �'�'+� t x T'" r f # �i � � 's.�, y? �� .ik , �`tx�"'xk e� Z �`3,�i� �* �.� <br /> �. `''2�� � � h�t � � ,� �p�lo�l��fi��Ti�l>I� r�AT�l�r�1 ��..:� �� 'v <br /> � <br /> PROJECT ADDRESS: 500-5 yv cots\rk6 d Ce4ky9 ewYMMt) u " 3;. bld. i7rM1oor F, II.v) <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> 3c 2., s,� ... t a r q.4 t � i 4$• <br /> e r`:�ak�n'�:�7��.� C�'� t �`��r w�k2• <br /> � �� 1dahX.:.. <br /> � ,a � �ct��c"• <br /> � was �e r a k ��'� - � �v4x �� � ,+Y, <br /> CONTRACT PRICE OF WORK:$ Fj,000 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 12(NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 30 OCT, L\R v C1 rcUi1 <br /> cONTA'CT INFQRIVIATION <br /> OWNER NAME: &0Qi1(1.) EveytAL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: DW% FyaLoi (tc\u orA <br /> CONTRACTOR ADDRESS: STREET pa w( '�j,n(Qu, <br /> �(� <br /> ( CITY �j()me*, �s\P c ?\/t W GT STATE \NIA ZIP ci o u <br /> CONTRACTOR PHONE: \(.)G" 13 U B ,-h CONTRACTOR EMAIL: (3,ffik\I AWAY I VIU(A11L'. cowl <br /> CONTRACTOR LIC.#(REQUIRED): 5112)\0\ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): l 2 <br /> PRIMARY CONTACT: u OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 16(Q <br /> 1B8� 2.7) <br /> CONTACT EMAIL: em cUmM i <br /> y. « <br /> AGREEMENT'I 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 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 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 /> 01 <br /> PERMIT#.11 <br /> e\ 211 'x01 tO9 ►u <br /> ate Revised 9/23/2016) <br /> Ow :/Authorized Agent Si na e D � <br />