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"11.40 ---4 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> v .iii&rli <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT;SITEINFORMATiION , r_ <br /> PROJECT ADDRESS: 30 D75 LOQ \- a IA.o \kc.X re ' (4.O-59 Cc&& J '2 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) N/A,, SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: XCOMMERCIAL <br /> USE OF BUILDING: AlrCCP-k'lt' •SS.Q.A,A.kJ`...I <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z$ ZOO.00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES )4 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Q,JC. cbk.0 V Q ':j(7 .(a\AA\ — t4c6O Q.,.k,c CuLA k <br /> CONTACT INFORMATION <br /> OWNER NAME: Qe_k\\,e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -OD'3 W Q c vA ¶ek <br /> Z.V e,t-k CITY w A STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �V\t r j ps A 10' VGk,Q.CkATA.C. MA-C.-- <br /> CONTRACTOR <br /> V% Q .CONTRACTOR ADDRESS: STREET 1,(i\VI VVI 3V\ N-' . (} '�c�1 ^ <br /> CITY "V-Ubr�,f'\ STATE W ( ZIP C ,�'W moi' <br /> CONTRACTOR PHONE:4'L meati-1cs-03 CONTRACTOR EMAIL: Guo v\a r @ min ov(J. - e.-CLQ. C,CAWS. <br /> CONTRACTOR LIC.#(REQUIRED)I.YWhOV.t cz.SS\' . CITY OF EVERETT BUSINESS LIC.#(REQUIRED):3G8I© <br /> PRIMARY CONTACT: 0 OWNER IV<CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 1 ` CONTACT PHONE: 1... 'Z,O _—t h o3 <br /> GuV <br /> .vAN-c �e.CZ.O`O\ CONTACT EMAIL: <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 /> ( e50 <br /> PERMIT# � — ICI <br /> —% q--=.\\ \\` . E l�0 11 <br /> Own. thorized Agent Sign Date (Revised 10/12/2015) <br />