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°4F4g77- IICTRICAL PERMIT APFLICATION <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 /> P EC `SITE INFORMA' I O <br /> PROJECT ADDRESS: 3 2 S 6,1i , A v-c. 'k, 7) <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: citCOMMERCIAL <br /> USE OF BUILDING: A'S 7 d •y �_, <br /> ELECTRICAL,APPLICATION I (FORMA "IrON . <br /> CONTRACT PRICE OF WORK:$ L5 DO, <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicabl 17/0 -. 0 (0 <br /> DESCRIPTION OF WORK: <br /> �l�t J S nnom` /b v✓ t42/ �.f VY c:71- ILL ci4 7Nt/J J <br /> (t r live_ vl1 o s vh I.. <br /> CONTACT INFORMATION <br /> OWNER NAME: rS! &/' c 4 CA.vc& TENANT NAME(If Commercial): !J[, 5r ,734, r <br /> 5,r� eyg. <br /> OWNER MAILING ADDRESS: STREET 2. v 2. '7 C.(e✓ ,41/1-A" <br /> CITY L STATE kAA.1- ZIP 8 2,(,r J <br /> OWNER PHONE: OWNER EMAIL: 13C i412t/)rk)& Cods 7 v / Col", <br /> CONTRACTORNAME: l\o✓��c`c- wl ✓C `M�,c / C <br /> CONTRACTOR ADDRESS: STREET pp i3p?C (S`z/S"" <br /> CITY I r 1.%11 STATE W 6- ZIP J v 2 3' 3 <br /> CONTRACTOR PHONE: 3 Coo—X37?- I,3 (CONTRACTOR EMAIL: ,l e vto✓-c((c k vnto <br /> CONTRACTOR LIC.#(REQUIRED): i\iv s D/7"RC 93S"L..3 CITY OF EVERETT BUSINESS LIC.#(REQUIRE ): 2.417 7 8( <br /> PRIMARY CONTACT: 0 OWNER LONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3( v-- b7 3^ bit 3 <br /> (�. <br /> (41)",./i j CONTACT EMAIL: I �ca @✓t dr�(i G'F��"��c-o✓, /. irvK <br /> AGREEMENT.I 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 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 /> PERMIT# <br /> i0-30—(7 E \11,0' <br /> rlAuthorized Agent Signature Date (Revised 9/23/2016) <br />