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/111116%.77-7:4 LLECTRICAL PERMIT AFIPLICATION <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)everefteps@everettwa.gov! www.everettwa.gov/permits <br /> tef( <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: GO7 nA � �( x,‘I -� 4r�H <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED El SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: )(COMMERCIAL <br /> USE OF BUILDING: Cjitormr (a f - <br /> ELECTRICAL APPLICATION INFORMATION ' <br /> CONTRACT PRICE OF WORK:$ A 5 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? *ES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1 n Si 1` (I) t�?� (° y)ne-1 leAltrg s `.elO-d,1&Play <br /> • CONTACT_INFORIItfATION. ;. • <br /> OWNER NAME: TENANT NAME(If Commercial): f Li a"s 10Ct v Ly <br /> OWNER MAILING ADDRESS: STREET <br /> 7 <br /> CITY STATE ZIP <br /> OWNER PHONE: c OWNER EMAIL: <br /> CONTRACTOR NAME: �P�T SIgn 52XV ices _ w. <br /> CONTRACTOR ADDRESS: sTREEr�J I W i i�, !�'1 E'��re I Fa-39 <br /> / <br /> Cm m It' C/mo STATE ZIP Q/ <br /> CONTRACTOR PHONE: V CONTRACTOR EMAIL: I'�'}'�j vj)�.Q �n CO(VY\ <br /> CONTRACTOR LIC.#(REQUIRED):ON,S91 CITY OF EVERETT BUSINESS LIC#(REQUIRED): ®S5 'oil <br /> PRIMARY CONTACT: CI OWNER )ICCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: FranR CONTACT PHONE: 9z5 33 Q;eiW <br /> CONTACT EMAIL: bbr5u\y 61nsn " in. <br /> T <br /> AGREEMENT hereby certify that 1 have read and examined this application and know the same to be true an 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 tam authorized by the owner of this properly 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 /> (5'n <br /> PERMIT# <br /> a" z�, ) IE 11t)2''2 <br /> Own r/Authoriz d Agent Si. . • Date (Revised 10/12/2015) <br />