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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 /> „,.'11 .';;;;;V:?:-'2,::::,:' PROJECT SITE INFORMATION” q <br /> PROJECT ADDRESS: 6 I -i C° o-f'.. S4 ( na-r n ( ia,I '` YT 5CC.(,C-S je r e&'4 .1,,i \ <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 /> ,t ; ELECTRICAL:APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES(if low voltage): 1 `4" k_Ides- ) ( , arjytce Ss,ILcV S <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Co (241 ( 4-6.1 0 eve.seeA `A "S G.- 2 i" ec4—1 veli <br /> CONTACT INFORMATION <br /> OWNER NAME: CO ( Ayyt (plc rYt.,T TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> 5 / t � � j j <br /> �!CITY �elle) <br /> STATE p" <br /> ZI / 2-/1 <br /> OWNER PHONE: ® • (0O(0,I b OWNER EMAIL: Orr,Li61dS(tJCKmsem . <br /> 1-, , <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): FteeLl C <br /> PRIMARY CONTACT: )]OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: `� CONTACT PHONE: 366. C 1-7 b t <br /> A'nrv,, Ste` t-44/1 CONTACT EMAIL: ex Ca k(`/i j@ WILL 0 e iv-uh `¢�. <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct rovisions 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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> asixt,a <br /> .6/2, 9 . (' ''( E 1 �ti°1-b�� <br /> anJoSAuthorize Age Si'nature Date (Revised 9/23/2016) <br />