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4000,.. . <br /> LECTRICAL PERMIT AHDLICATION <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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 251 f Coe-13Y 4J(i- <br /> • <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: CgfCOMMERCIAL <br /> USE OF BUILDING: /1.1 t esnmazot- (!) t G 1E-- <br /> - <br /> --- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 35v <br /> NUMBER OF DEVICES(if low voltage):, t <br /> FIRE ALARM? 0 YES NI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: I/J5Tizi a.— t l fM/iViet-ni3D S 1C7/l) <br /> _ . <br /> CONTACT INFORMATION <br /> OWNER NAME: CoL(3y C 1&1 ZT 65s- LZ-C- TENANT NAME(If Commercial): 1410-1.-M-72145 l0\)‘4y51—Plt <br /> OWNER MAILING ADDRESS: STREET /0 Z(2 LU 5l&Jo RIS <br /> CIN Et`CAZ�� STATE t/lJel" ZIP `43.7-0L <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: W Ti-.S7 N ") <br /> CONTRACTOR ADDRESS: STREET ?AC)2- L41- PI-UTC.- 5 Q <br /> CIW ..i-- Lr STATE tAJ Qr� ZIP 49 134-, <br /> CONTRACTOR PHONE: 206 6'8'l 7732 CONTRACTOR EMAIL: CJ G LJIS/L I J/Jij2 J dL <br /> CONTRACTOR LIC.#(REQUIRED): k437-4.:A/1©�lcj©tom-- CITY OF EVERETT BUSINESS LIC.#(REQUIRED):e 9 l 3 <br /> PRIMARY CONTACT: 0 OWNER a 4! CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> r CONTACT PHONE: 'may 6`c3'Z -2736 <br /> G3vJlt-L- IQ" 5j CONTACT EMAIL: c ?t-J t 12i 2 N)IONmeb",---7 <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 lam 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 /> J , <br /> PERMIT# <br /> c <br /> / 14/7-0)e E Iq b (-Ou6 <br /> Owne •uth- ized Agen Signature Dat (Revised 10/12/2015) <br />