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477 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 91 a--1 E YE 12C i E N .J poi <br /> BUILDING AREA(if residential, new constructioni[remodel�pr addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: 0 RTI,OQST CLINI (, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ qrq 3.(1)c) <br /> NUMBER OF DEVICES (if low voltage): b KT DfLoPS Gv 7 <br /> FIRE ALARM? 0 YES 14 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: \titS�AU. •S• (%MN�1AI'S DATA\COwAM Dcic QS Eo{t_ NeTvl�&V-. <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): Ge o0.0 DicT‘Aoc,,,t,41-tc.S <br /> OWNER MAILING ADDRESS: STREET47a1 EV1:RC,1 vv Ai <br /> CIN tvElLST STATE W A ZIP C\% <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: N.PPL\Et %V 1Sln1g5S N,(ATI oN5 J A6Com <br /> CONTRACTOR ADDRESS: STREET \'o\ \N pvSTA-i D tl L� <br /> CITY \v\Wt\\(n STATE W A. ZIP p <br /> CONTRACTOR PHONE: \•'3 M• 66)•-• ea.if,Io CONTRACTOR EMAIL: ece S4.1 @ a bcoml\C-CO In -N <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQU ED): 5206cl <br /> PRIMARY CONTACT: 0 OWNER NCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: E Q.\C, CASPE"(L CONTACT PHONE: L}•LS• 23 6• q c)1 c1 <br /> CONTACT EMAIL: P.,GASetrQ oJoCo \\ . c,om <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 /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />