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041-77 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/ rmits <br /> _ ,;: .:1!:,110.400T:Mirg:MFORMATION''; -.. _•.• . • -_ :: _: <br /> . °: <br /> PROJECT ADDRESS: 3003 WEST LsA54 MO P-0Ab' -11/4/1EFZETT j WA lea04- * T-lo-37 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) N/A SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: jeCOMMERCIAL <br /> USE OF BUILDING: I MbUSTE-IAL/CoIAMEg_CtAcL... <br /> ELECTRICAL APPLICATION INFORMATION , <br /> CONTRACT PRICE OF WORK:$ /61/i 7 <br /> NUMBER OF DEVICES(If low voltage): N A <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable): tq/A <br /> DESCRIPTION OF WORK: remi Ag OO,�sTZZI)a77oN Por✓EA BI M1Clf CIRCI)IT AIODIFICATIa7J, <br /> 1.J4a I71A1G ol(LE FAX.--o /)KPGAOEMeNTTP•EFUl2,45ist1Me0i- <br /> DeVLCE(cVE-Fr 'OWE REPLACEM /4T 4 b1/4/5-774-41.-6PCI MEAKERS <br /> ' • • CONTACT INFORMATION ';':,•'.:::• z <br /> OWNER NAME: Boal NG TENANT NAME(If Commercial): Bolt.J <br /> OWNER MAILING ADDRESS: STREET pa gag. ?C�TO7 (�q n <br /> CITY AT'rt-.E STATE WA 71P 1;424-7'^7 <br /> OWNER PHONE: J12. 51-4-. 2CXDO OWNER EMAIL: NVA <br /> CONTRACTOR NAME: gUoy l M.. TV.-iG L-LC- <br /> CONTRACTOR ADDRESS: STREET 16155-t35 I. OtZtfl) S2r <br /> CITY 'DM0t.1qD STATE WA zip 15052' <br /> CONTRACTOR PHONE: 425,814.loom CONTRACTOR EMAIL: 9°artJ. .tack an5eh ea sel 9.3et1.C.arvi <br /> CONTRACTOR LIC.#(REQUIRED): sea JOt..9-1-1 59 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 1 415 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.229..2,545 <br /> SIM At..tbt'—Sot`l,a -t4Er—AL )t Mak.k1 CONTACT EMAIL: r j.irn.r ne er3on @ se y oyat.0-en-vi <br /> AGREEMENT 1 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 slate 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! <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> GARY A B ER <br /> -22- E k.g,Dg- k 149 <br /> Owner/Authorized Agent Signature brat (Revised 8x13/2016) <br />