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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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 12 c CO` Aoa <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: ( COMMERCIAL <br /> USE OF BUILDING: i-10 kG <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ i SZO ° <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES QI O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Apprbx, toor-t- CO.1du 4 r- a Cevutem fo /PO( 414C_ <br /> Piprox ,904 co ( , k /,isicat / t opfv5,:•lt.. (� <br /> C'sC 1S y`c ( IA- tt5 lic 3d- A kr- wn'I( t r-/cec(- <br /> CONTACT INFORMATION <br /> OWNER NAME: ?Pro J d et'tcL /±5i-(1)44.!/ Aect,az/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ISO I 40-V1 <br /> i lt A 5:4) o <br /> cn- Reit 40- ` STATE 604 ZIP d <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: &CA— E (ecIr.: ., <br /> CONTRACTOR ADDRESS: eraser S`prII fi+ $ `-' /� <br /> C17Y T_ C+. STATE INI4 ZIP �eIV4 <br /> CONTRACTOR PHONE: 2O6?,—/113C,_ ZOO CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUJREO): Ytc4EGJ- 5L(Z M O CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 00 17146-- <br /> PRIMARY <br /> 7141._$-PRIMARY CONTACT: CI OWNER ,ZCONTRACTOR 0 OTHER(Please Specify) r t Guerra ( Force <br /> CONTACT NAME: p ( CONTACT PHONE: 066 esO -49 3 <br /> 1'r oc.i .144 1t L CONTACT EMAIL: Scaps. Sc 4t Cte id l.._ L&4 <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisiocs of laws and ordinances governing this tYAe <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 Jam 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 /> PERMIT# <br /> �i. 5 E $o5-(Rio . <br /> 0 • /Authorize* •gent Signature Date (Revised 9/23/2016) <br />